Active NPI
Carl Louis Buckner, MD
- Anatomic Pathology & Clinical Pathology Physician
- Concord, NC
National Provider Identifier
1295814911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 2009-01192
- Practice address
- 920 Church St N
Concord, NC 28025-2927 - Phone
- (704) 403-3100
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 2009-01192 | NC | Primary |
Addresses
Primary practice location
920 Church St N
Concord, NC 28025-2927
Mailing address
920 Church St N
Concord, NC 28025-2927
Phone (704) 403-3100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5912236 | Medicaid | NC | |
| P00750150 | Other | RAILROAD MEDICARE | |
| 1531C | Other | NC | BLUE CROSS BLUE SHIELD NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160802002575 | OH | Practitioner - Pathology | 6204989262 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009-01192 | NC | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Ohio Pathology Consultants Inc | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
Locations
3000 Hospital Dr
Batavia, OH 45103
Phone (513) 557-3209
375 Dixmyth Ave
Cincinnati, OH 45220
Phone (513) 862-2432
Organizations & group practices 1
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Cincinnati, OH
- NPI 1831173202
Anatomic Pathology & Clinical Pathology, OH
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Cincinnati, OH
- NPI 1235239211
Hospital
-
- General Acute Care Hospital
- Batavia, OH
- NPI 1568562551
Hospital
-
- General Acute Care Hospital
- Fairfield, OH
- NPI 1467552471
Hospital
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- University of Cincinnati College of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern Ohio Pathology Consultants, Inc.
Practice addresses (Care Compare)
375 Dixmyth Ave
Cincinnati, OH 45220-2475
Phone (513) 865-1321
Hospital & facility affiliations
- Mercy Health - Clermont Hospital
- Mercy Health - West Hospital
- Mercy Health-Anderson Hospital
- Mercy Health Kings Mills Hospital LLC
- Mercy Health - Fairfield Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257811200000",
"number": "1295814911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 CHURCH ST N",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252927",
"telephone_number": "704-403-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 CHURCH ST N",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252927",
"telephone_number": "704-403-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKNER",
"first_name": "CARL",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2009-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NC",
"license": "2009-01192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5912236",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00750150",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "1531C",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.