Active NPI
South Lake Pediatrics
- Pediatrics Physician
- Huntersville, NC
National Provider Identifier
1295766079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- SOUTH LAKE PEDIATRICS
- Practice address
- 9625 Northcross Center CT
Ste 201
Huntersville, NC 28078-7348 - Phone
- (704) 801-3097
- NPI assigned
- Jul 6, 2006
- Organization subpart
- Yes
- Parent organization
- SOUTH LAKE PEDIATRICS
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 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
- South Lake Pediatrics
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 Pediatrics
- 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.
-
- Pediatrics Physician
- Charlotte, NC
- NPI 1619203791
-
- Pediatrics Physician
- Denver, NC
- NPI 1740755610
Locations
9625 Northcross Center Ct
Ste 30
Huntersville, NC 28078
16455 Statesville Rd
Ste 104
Huntersville, NC 28078
Phone (704) 892-3097
Practitioners & affiliated clinicians
Practitioners 17
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Huntersville, NC
- NPI 1437416211
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
- Erin Somerville, MA, BCBA
- Sona Medspa Physician Group, PLLC
- Carolyn A. Souders, LCSW
- South Lake Audiology, Inc.
- South Lake Ears Nose & Throat PA
- Southeastern Seating and Mobility Consulting LLC
- Southern Oncology Specialists, PLLC
- Southern Oncology Specialists, PLLC
- Southlake Family and Cosmetic Dentistry
- Temitayo Omoteleola Soyoye, NP
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.