Active NPI
John Charles Harrison, PA-C
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1184617151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 21412
- Practice address
- 9848 N Tryon St
Charlotte, NC 28262-5512 - Phone
- (704) 323-2000
- NPI assigned
- Aug 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 21412 | NC | Primary |
Addresses
Primary practice location
9848 N Tryon St
Charlotte, NC 28262-5512
Mailing address
4601 Park Rd
Suite 300
Charlotte, NC 28209-3239
Phone (704) 323-2000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89015XT | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251001004770 | NC | Order and Referring Only - Physician Assistant | 1759471907 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21412 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283126400000",
"number": "1184617151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 PARK RD",
"address_2": "SUITE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093239",
"telephone_number": "704-323-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9848 N TRYON ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282625512",
"telephone_number": "704-323-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "JOHN",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-25",
"last_updated": "2010-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "21412",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89015XT",
"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 Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.