NPIMap

Organization Active NPI

Queen City Ear Nose and Throat PLLC

  • Otolaryngology Physician
  • Charlotte, NC
National Provider Identifier
1174183156
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
QUEEN CITY EAR NOSE AND THROAT PLLC
Practice address
8924 Blakeney Professional Dr
Charlotte, NC 28277-6660
Phone
(704) 996-5353
NPI assigned
Jun 20, 2019
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Daron James Smith, MDNPI 1245262096
Title
Physician
Phone
(704) 703-1080

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

8924 Blakeney Professional Dr
Charlotte, NC 28277-6660

Mailing address

8924 Blakeney Professional Dr
Charlotte, NC 28277-6660
Phone (704) 703-1080

Other practice location 1

1994 Wellness Blvd Ste 210
Monroe, NC 28110-7768
Phone (704) 996-5353

Other identifiers 1

IdentifierTypeStateIssuer
1174183156OtherNCNATIONAL PROVIDER IDENTIFIER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191014002660 NC Part B Supplier - Clinic/Group Practice 0941531487 Receives reassigned benefits from 8 practitioners
Practice locations: Charlotte, NC; Monroe, NC
O20201125000638 SC Part B Supplier - Clinic/Group Practice 0941531487 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Mill, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1174183156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8924 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776660",
            "telephone_number": "704-703-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8924 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776660",
            "telephone_number": "704-996-5353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1994 Wellness Blvd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281107768",
            "country_code": "US",
            "telephone_number": "704-996-5353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "QUEEN CITY EAR NOSE AND THROAT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DARON",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "704-703-1080",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER IDENTIFIER",
            "identifier": "1174183156",
            "state": "NC"
        }
    ],
    "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 Feb 1, 2022; 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.