NPIMap

Organization Active NPI

Caromont Medical Group, Inc.

Doing business as CaroMont Pediatric Partners

  • Pediatrics Physician
  • Gastonia, NC
National Provider Identifier
1194904706
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CAROMONT MEDICAL GROUP, INC.
Doing business as
CaroMont Pediatric Partners
Practice address
705 Summit Crossing PL
Ste 150
Gastonia, NC 28054-2216
Phone
(704) 671-6300
Fax
(704) 671-6307
NPI assigned
Oct 31, 2007
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROMONT MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
David Michael Oconnor
Title
Cfo
Phone
(704) 671-5343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

705 Summit Crossing PL
Ste 150
Gastonia, NC 28054-2216

Mailing address

PO Box 744786
Atlanta, GA 30374-4786
Phone (704) 834-2450

Other identifiers 2

IdentifierTypeStateIssuer
0139TOtherNCBCBS
6901041MedicaidNC

Other names 1

  • CaroMont Pediatric Partners Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000070 NC Part B Supplier - Clinic/Group Practice 3577476258 Receives reassigned benefits from 760 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Gastonia, NC; Kings Mountain, NC; Lenoir, NC; McAdenville, NC; Morganton, NC; Shelby, NC; Stanley, NC; Belmont, NC…

National Provider Directory

National Provider Directory
Part of
Caromont Medical Group in

Locations

705 Summit Crossing Pl
Ste 150
Gastonia, NC 28054
Phone (704) 671-5300

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1194904706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744786",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744786",
            "telephone_number": "704-834-2450",
            "fax_number": "704-671-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SUMMIT CROSSING PL",
            "address_2": "STE 150",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542216",
            "telephone_number": "704-671-6300",
            "fax_number": "704-671-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROMONT MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROMONT MEDICAL GROUP INC",
        "enumeration_date": "2007-10-31",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-671-5343"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0139T",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6901041",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CaroMont Pediatric Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.