NPIMap

Organization Active NPI

South Lake Pediatrics

Doing business as Atrium Health Levine Children's South Lake Pediatrics

  • Pediatrics Physician
  • Huntersville, NC
National Provider Identifier
1295766079
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTH LAKE PEDIATRICS
Doing business as
Atrium Health Levine Children's South Lake Pediatrics
South Lake Pediatrics
Practice address
9625 Northcross Center CT
Ste 201
Huntersville, NC 28078-7348
Phone
(704) 801-3097
NPI assigned
Jul 6, 2006
Last updated
Mar 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH LAKE PEDIATRICSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

9625 Northcross Center CT
Ste 201
Huntersville, NC 28078-7348

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 2

  • Atrium Health Levine Children's South Lake Pediatrics Doing business as
  • South Lake Pediatrics Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

National Provider Directory

National Provider Directory
Tax ID family
South Lake Pediatrics3 organizations share this tax ID, including this one
Part of
South Lake Pediatrics

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

16455 Statesville Rd
Ste 104
Huntersville, NC 28078
Phone (704) 892-3097

9625 Northcross Center Ct
Ste 30
Huntersville, NC 28078

1663 Campus Park Dr
Ste A
Monroe, NC 28112
Phone (704) 261-1220

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1295766079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 NORTHCROSS CENTER CT",
            "address_2": "STE 201",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787348",
            "telephone_number": "704-801-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE PEDIATRICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH LAKE PEDIATRICS",
        "enumeration_date": "2006-07-06",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "9625 Northcross Center Ct",
            "address_2": "Ste 201",
            "city": "Huntersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280787348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Levine Children's South Lake Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Lake Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.