NPIMap

Individual provider Active NPI

Jeffrey John Ralston, DO

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1275538449
Registry record updated Sep 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
200400578 Issued in NC
Practice address
3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117
Phone
(704) 332-1291
Fax
(704) 926-1832
NPI assigned
Jun 15, 2005
Last updated
Sep 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X 2004-00578 NC
Diagnostic Radiology Physician 2085R0202X 200400578 NC Primary

Addresses

Primary practice location

3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117

Mailing address

PO Box 221249
Charlotte, NC 28222-1249
Phone (704) 332-1291

Other practice location 1

1515 W Innes St
Salisbury, NC 28144-2503
Phone (704) 633-1022

Other identifiers 2

IdentifierTypeStateIssuer
89137J0MedicaidNC
1275538449MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040805001573 NC Practitioner - Diagnostic Radiology 8325019805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
West Virginia School of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

Practice addresses (Care Compare)

3623 Latrobe Dr
Suite 216
Charlotte, NC 28211-2117
Phone (704) 332-1291

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
98.89
Improvement activities
40
Cost
72.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004-00578NCMDNuclear Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Mecklenburg Radiology Associates, P.a. Diagnostic Radiology CurrentSince Jan 1, 2015 Accepting new patients
Presbyterian Breast Center LLC Diagnostic Radiology CurrentSince Jan 1, 2023 Accepting new patients
Cabarrus Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2009 Accepting new patients
Presbyterian Breast Center LLC Diagnostic Radiology CurrentSince Apr 1, 2022 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients
Piedmont Radiological Associates, P.a. Diagnostic Radiology PastSince Jul 1, 2005 Accepting new patients

Locations

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone (704) 926-1827

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599955200000",
    "number": "1275538449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221249",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221249",
            "telephone_number": "704-332-1291",
            "fax_number": "704-332-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR STE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112117",
            "telephone_number": "704-332-1291",
            "fax_number": "704-926-1832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 W Innes St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281442503",
            "country_code": "US",
            "telephone_number": "704-633-1022",
            "fax_number": "704-633-6711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RALSTON",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2020-09-13",
        "certification_date": "2020-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "NC",
            "license": "2004-00578",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200400578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89137J0",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275538449",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.