NPIMap

Organization Active NPI

The Charlotte-Mecklenburg Hospital Authority

  • Dermatology Physician
  • Concord, NC
National Provider Identifier
1174950752
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Practice address
200 Medical Park Dr
Ste 460
Concord, NC 28025-2982
Phone
(704) 403-2777
NPI assigned
Sep 27, 2013
Organization subpart
Yes
Parent organization
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

200 Medical Park Dr
Ste 460
Concord, NC 28025-2982

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other practice location 1

1100 Healing Way
Ste 11-B
Matthews, NC 28104-4951
Phone (704) 403-2777

Other names 2

  • Atrium Health Dermatology Doing business as
  • NorthEast Dermatology Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100309000605 NC Part B Supplier - Clinic/Group Practice 2961310685 Receives reassigned benefits from 1,831 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2037113Cmha Dba Atrium Health Dermatology Concord200 Medical Park Drive, Suite 460, Concord, NC 28025RegistrationSep 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Mecklenburg Hospital Authority103 organizations share this tax ID, including this one
Part of
Charlotte Mecklenburg Hospital Authority

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

923 N 2nd St
Albemarle, NC 28001
Phone (980) 323-5600

15940 Brixham Hill Ave
Charlotte, NC 28277
Phone (561) 271-3428

9908 Couloak Dr
Ste 100
Charlotte, NC 28216
Phone (704) 801-3065

7825 Ballantyne Commons Pkwy
Charlotte, NC 28277
Phone (704) 446-0391

400 E Morehead St
Ste 100
Charlotte, NC 28202
Phone (704) 355-7360

3030 Randolph Rd
Ste 105A
Charlotte, NC 28211
Phone (704) 512-4420

200 Medical Park Dr
Ste 320
Concord, NC 28025
Phone (704) 403-2760

200 Medical Park Dr
Ste 460
Concord, NC 28025
Phone (704) 403-2777

5200 NC Highway 49 S
Harrisburg, NC 28075
Phone (704) 455-2044

16455 Statesville Rd
Ste 300
Huntersville, NC 28078
Phone (704) 801-3719

1100 Healing Way
Stallings, NC 28104
Phone (704) 246-1566

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1174950752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK DR",
            "address_2": "STE 460",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252982",
            "telephone_number": "704-403-2777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Healing Way",
            "address_2": "Ste 11-B",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281044951",
            "country_code": "US",
            "telephone_number": "704-403-2777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY",
        "enumeration_date": "2013-09-27",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1100 Healing Way",
            "address_2": "Ste 11-B",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281044951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorthEast Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.