NPIMap

Organization Active NPI

Presbyterian Sameday Surgery Center at Ballantyne LLC

Doing business as Novant Health Ballantyne Outpatient Surgery Crna

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1154857662
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
PRESBYTERIAN SAMEDAY SURGERY CENTER AT BALLANTYNE LLC
Doing business as
Novant Health Ballantyne Outpatient Surgery Crna
Practice address
14215 Ballantyne Corporate PL Ste 210
Charlotte, NC 28277-3873
Phone
(704) 316-2650
Fax
(704) 316-2653
NPI assigned
May 3, 2017
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Fred M Hargett
Title
Evp Cfo
Phone
(704) 384-5184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary

Addresses

Primary practice location

14215 Ballantyne Corporate PL Ste 210
Charlotte, NC 28277-3873

Mailing address

2085 Frontis Plaza Blvd
Winston Salem, NC 27103-5614
Phone (336) 277-7226

Other names 1

  • NOVANT HEALTH BALLANTYNE OUTPATIENT SURGERY CRNA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070928000739 NC Part B Supplier - Ambulatory Surgical Center 4587759949 Receives reassigned benefits from 536 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Ballantyne Outpatient Surg2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 510

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 510

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1154857662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035614",
            "telephone_number": "336-277-7226",
            "fax_number": "336-277-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14215 BALLANTYNE CORPORATE PL STE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773873",
            "telephone_number": "704-316-2650",
            "fax_number": "704-316-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN SAMEDAY SURGERY CENTER AT BALLANTYNE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "HARGETT",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EVP CFO",
        "authorized_official_telephone_number": "704-384-5184"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOVANT HEALTH BALLANTYNE OUTPATIENT SURGERY CRNA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NOVANT HEALTH BALLANTYNE OUTPATIENT SURGERY CRNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.