NPIMap

Organization Active NPI

Ballantyne Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1164052726
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
BALLANTYNE EMERGENCY PHYSICIANS PLLC
Practice address
11516 Providence Rd
Charlotte, NC 28277-2691
Phone
(704) 667-0370
NPI assigned
Jan 23, 2020
Last updated
Jun 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Kim H Larsen
Title
Director of Credentialing
Phone
(770) 874-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

11516 Providence Rd
Charlotte, NC 28277-2691

Mailing address

5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834
Phone (770) 874-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200513000736 NC Part B Supplier - Clinic/Group Practice 8123459898 Receives reassigned benefits from 151 practitioners
1 other NPI on this 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

Practitioners & affiliated clinicians

Practitioners 152

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 152

NPI Registry JSON

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1164052726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR STE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285834",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11516 PROVIDENCE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772691",
            "telephone_number": "704-667-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLANTYNE EMERGENCY PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 17, 2020; 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.