Individual provider Active NPI

Kasey Wymer Scannell, MD

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1194853457
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2009-00726 Issued in NC
Practice address
6010 Carnegie Blvd
Charlotte, NC 28209-4637
Phone
(704) 384-9966
Fax
(704) 384-9967
NPI assigned
Mar 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2009-00726 NC Primary

Addresses

Primary practice location

6010 Carnegie Blvd
Charlotte, NC 28209-4637

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

13640 Steelecroft Pkwy
Suite 210
Charlotte, NC 28278
Phone (704) 512-6100

Other identifiers 3

IdentifierTypeStateIssuer
5912839MedicaidNC
1194853457MedicaidNC
N26000MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kscannell529276@direct.novanthealth.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090707000754 NC Practitioner - Pediatric Medicine 1355492190 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2009-00726NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NH Digital Health Services, LLC CurrentSince Sep 1, 2020 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 30, 2018 Accepting new patients
Novant Medical Group, Inc CurrentSince Jan 30, 2018 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
NH Digital Health Services, LLC CurrentSince Sep 1, 2020 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Carolinas Physicians Network Inc PastSince Dec 2, 2013 Accepting new patients

Locations

6010 Carnegie Blvd
Charlotte, NC 28209
Phone (704) 384-9966

4105 Matthews Mint Hill Rd
Matthews, NC 28105
Phone (704) 316-3095

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

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

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: kscannell529276@direct.novanthealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1194853457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 CARNEGIE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282094637",
            "telephone_number": "704-384-9966",
            "fax_number": "704-384-9967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13640 Steelecroft Pkwy",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28278",
            "country_code": "US",
            "telephone_number": "704-512-6100",
            "fax_number": "704-587-7601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCANNELL",
        "first_name": "KASEY",
        "middle_name": "WYMER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2009-00726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912839",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194853457",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N26000",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kscannell529276@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "13640 Steelecroft Pkwy",
            "address_2": "Suite 210",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.