Individual provider Active NPI

Aster Derar Ghebremedhin, M.D.

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1245292713
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9300124 Issued in NC
Practice address
6324 Fairview Rd Ste 350
Suite 350
Charlotte, NC 28210-4171
Phone
(704) 384-8600
Fax
(704) 384-8610
NPI assigned
Apr 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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 9300124 NC Primary

Addresses

Primary practice location

6324 Fairview Rd Ste 350
Suite 350
Charlotte, NC 28210-4171

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-8600

Other identifiers 2

IdentifierTypeStateIssuer
N00124MedicaidSC
8935228MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aghebremedhin14532@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
I20200505000454 NC Practitioner - Pediatric Medicine 0244479251 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9300124NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Mar 30, 2020 Accepting new patients
NH Digital Health Services, LLC CurrentSince Sep 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
NH Digital Health Services, LLC CurrentSince Sep 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Pediatrics CurrentSince Mar 30, 2020 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Novant Health Medical Group, LLC Pediatrics Past Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

6324 Fairview Rd
Ste 350
Charlotte, NC 28210
Phone (704) 384-8600

2711 Randolph Rd
Ste 501
Charlotte, NC 28207
Phone (704) 375-6831

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

Organizations & group practices 8

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": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1245292713",
    "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",
            "telephone_number": "704-384-8600",
            "fax_number": "704-384-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6324 FAIRVIEW RD STE 350",
            "address_2": "SUITE 350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282104171",
            "telephone_number": "704-384-8600",
            "fax_number": "704-384-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHEBREMEDHIN",
        "first_name": "ASTER",
        "middle_name": "DERAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-03",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9300124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00124",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8935228",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aghebremedhin14532@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "6324 Fairview Rd Ste 350",
            "address_2": "Suite 350",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282104171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.