Preston Pemberton Purdum III

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

9500190 Issued in NC

Practice address

300 Billingsley Rd Ste 200
Charlotte, NC 28211-1084

Phone

(704) 372-7974

Fax

(704) 372-5166

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Carolinas Medical Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment NPD
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Carolinas Medical Center

  • Urology Physician
  • Charlotte, NC
  • NPI 1992084198
  NPD
• Carolinas Pathology Group, PA

  • Specialist
  • Charlotte, NC
  • NPI 1689628158
  NPD
• Carolina Digestive Health Associates, PA

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
  • NPI 1063584415
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493856000000",
    "number": "1275566283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 CARMEL COMMONS BLVD",
            "address_2": "STE 302",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282265305",
            "telephone_number": "704-372-7974",
            "fax_number": "704-372-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BILLINGSLEY RD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111084",
            "telephone_number": "704-372-7974",
            "fax_number": "704-372-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURDUM",
        "first_name": "PRESTON",
        "middle_name": "PEMBERTON",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2017-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "9500190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8969467",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Omar Suresh Punjabi, M.D.
• Manvi Punukollu
• Ajith Kumar Puram, MD
• Kareem Puranda, NCC, LPC, LCAS
• McNeely Curtis Purcell, NP-C
• Sanpri Y Purdy-Porter, PT, IBCLC
• Julianna Purdy
• Katelyn Purdy
• Tonyia Purdy
• Pure Magic Health Solutions

• Gastroenterology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Gastroenterology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.