NPIMap

Organization Active NPI

Cabarrus Gastroenterology Associates, PLLC

Doing business as Northeast Digestive Health Center Edison Square

  • Gastroenterology Physician
  • Concord, NC
National Provider Identifier
1245776889
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
AS0104 Issued in NC
Legal business name
CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
Doing business as
Northeast Digestive Health Center Edison Square
Practice address
10030 Edison Square Dr NW
Suite 204
Concord, NC 28027-8308
Phone
(704) 783-1840
Fax
(704) 783-1850
NPI assigned
Jan 6, 2017
Last updated
Jan 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Authorized official

Name
Mark Aldous, MDNPI 1396754446
Title
Managing Partner
Phone
(704) 783-1840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X AS0104 NC Primary

Addresses

Primary practice location

10030 Edison Square Dr NW
Suite 204
Concord, NC 28027-8308

Mailing address

1070 Vinehaven Dr NE
Concord, NC 28025-2438
Phone (704) 783-1840

Other identifiers 10

IdentifierTypeStateIssuer
891031VMedicaidNC
89136HKMedicaidNC
1194142422MedicaidNC
1396923322OtherNCNPI
8926776MedicaidNC
8971386MedicaidNC
89128WYMedicaidNC
5904428MedicaidNC
710009300MedicaidNC
1508279043MedicaidNC

Other names 1

  • Northeast Digestive Health Center Edison Square Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000342 NC Part B Supplier - Clinic/Group Practice 9436059649 Receives reassigned benefits from 65 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Concord, NC; Salisbury, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Cabarrus Gastroenterolo4 organizations share this tax ID, including this one
Part of
Cabarrus Gastroenterolo

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9965 Poplar Tent Rd
Concord, NC 28027
Phone (704) 783-1840

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": "1483660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483660800000",
    "number": "1245776889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 VINEHAVEN DR NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252438",
            "telephone_number": "704-783-1840",
            "fax_number": "704-783-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10030 EDISON SQUARE DR NW",
            "address_2": "SUITE 204",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278308",
            "telephone_number": "704-783-1840",
            "fax_number": "704-783-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC",
        "enumeration_date": "2017-01-06",
        "last_updated": "2017-01-06",
        "status": "A",
        "authorized_official_last_name": "ALDOUS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "704-783-1840",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "AS0104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891031V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89136HK",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194142422",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396923322",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8926776",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8971386",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89128WY",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904428",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710009300",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508279043",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Digestive Health Center Edison Square",
            "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 Jan 6, 2017; 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.