NPIMap

Organization Active NPI

Caromont Medical Group, Inc.

Doing business as South Point Family Practice

  • Family Medicine Physician
  • Belmont, NC
National Provider Identifier
1265722318
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAROMONT MEDICAL GROUP, INC.
Doing business as
South Point Family Practice
Practice address
1220 Spruce St
Belmont, NC 28012-3370
Phone
(704) 825-5333
Fax
(704) 825-1751
NPI assigned
Apr 11, 2011
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 M Oconnor
Title
Cfo
Phone
(704) 834-2049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1220 Spruce St
Belmont, NC 28012-3370

Mailing address

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

Other practice location 1

159 E Dallas Rd
Stanley, NC 28164-2052
Phone (704) 263-0300

Other identifiers 2

IdentifierTypeStateIssuer
1265722318MedicaidNC
02FZKOtherNCBCBS

Other names 1

  • South Point Family Practice 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 Inc

Locations

600 W Trade St
Ste B
Dallas, NC 28034
Phone (980) 834-9170

4235 S New Hope Rd
Ste A
Gastonia, NC 28056
Phone (704) 825-4750

660 Summit Crossing Pl
Ste 301
Gastonia, NC 28054
Phone (704) 854-8799

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1265722318",
    "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": "1220 SPRUCE ST",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280123370",
            "telephone_number": "704-825-5333",
            "fax_number": "704-825-1751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 E Dallas Rd",
            "address_purpose": "LOCATION",
            "city": "Stanley",
            "state": "NC",
            "postal_code": "281642052",
            "country_code": "US",
            "telephone_number": "704-263-0300",
            "fax_number": "704-263-1873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROMONT MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROMONT MEDICAL GROUP INC",
        "enumeration_date": "2011-04-11",
        "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": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-834-2049"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265722318",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02FZK",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Point Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Point Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belmont, 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.