Individual provider Active NPI

Jonathan Kocmond, M.D.

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1265427520
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
200400368 Issued in NC
Practice address
1315 East Blvd
Suite 280
Charlotte, NC 28203-5975
Phone
(704) 384-1866
Fax
(704) 384-1867
NPI assigned
Sep 13, 2005
Sex
Male
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 200400368 NC Primary

Addresses

Primary practice location

1315 East Blvd
Suite 280
Charlotte, NC 28203-5975

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1866

Other identifiers 1

IdentifierTypeStateIssuer
89136TPMedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkocmond15602@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
I20040816000633 NC Practitioner - Pediatric Medicine 1557334869 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 28, 2023 Accepting new patients
Novant Health Medical Group LLC Pediatrics CurrentSince May 28, 2023 Accepting new patients
Novant Health Medical Group, LLC Pediatrics Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1315 East Blvd
Ste 280
Charlotte, NC 28203
Phone (704) 384-1866

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

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

Organizations & group practices 5

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": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1265427520",
    "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": "704-384-1866",
            "fax_number": "704-384-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 EAST BLVD",
            "address_2": "SUITE 280",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035975",
            "telephone_number": "704-384-1866",
            "fax_number": "704-384-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCMOND",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200400368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89136TP",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkocmond15602@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1315 East Blvd",
            "address_2": "Suite 280",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.