CMC-Northeast, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CMC-NORTHEAST, INC.

Practice address

10030 Edison Square Dr NW
Suite 100
Concord, NC 28027-8252

Phone

(704) 403-7830

Fax

(704) 403-7840

NPI assigned

Feb 12, 2010

Organization subpart

Yes

Parent organization

CMC-NORTHEAST, INC.As reported in NPPES

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

Authorized official

Name

Mrs. Frieda M Lowder

Title

Sr. VP

Phone

(704) 403-4146

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Edison Square Family Medicine Doing business as

Part of

CMC Northeast

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Lee Fanning Jr., M.D.

  • Infectious Disease Physician
  • Concord, NC
  • NPI 1639146780
  NPD (past)
• Robert Moser, MD

  • Internal Medicine Physician
  • Kannapolis, NC
  • NPI 1023080934
  NPD (past)

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283990400000",
    "number": "1265764443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10030 EDISON SQUARE DR NW",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278252",
            "telephone_number": "704-403-7830",
            "fax_number": "704-403-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10030 EDISON SQUARE DR NW",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278252",
            "telephone_number": "704-403-7830",
            "fax_number": "704-403-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-09-09",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. VP",
        "authorized_official_telephone_number": "704-403-4146",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN, GROUP",
            "identifier": "232009",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914718",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DF8926",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edison Square Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.
• CMC-Northeast, Inc.

• Family Medicine Physician in Concord, NC
• Providers in Concord, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.