Individual provider Active NPI

Nichole Ann Waltz, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1295995462
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-01323 Issued in NC
Practice address
416 E 36TH St
Ste 200
Charlotte, NC 28205-1030
Phone
(980) 302-9800
Fax
(980) 302-9810
NPI assigned
Jun 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-01323 NC Primary

Addresses

Primary practice location

416 E 36TH St
Ste 200
Charlotte, NC 28205-1030

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

332 N Trade St
Suite 2000
Matthews, NC 28105-1728
Phone (704) 302-8500

Other practice location 2

200 S College St
Suite 500
Charlotte, NC 28202-2012
Phone (704) 302-8800

Other practice location 3

10650 Park Rd
Suite 420
Charlotte, NC 28210-8538
Phone (704) 302-8700

Other practice location 4

15110 John J Delaney Dr
Suite 200
Charlotte, NC 28277-3544
Phone (704) 302-8100

Other practice location 5

11304 Hawthorne Dr
Suite 100
Mint Hill, NC 28227-9425
Phone (704) 545-6400

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080826000821 NC Practitioner - Physician Assistant 5799850772 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

416 E 36TH St
Suite 200
Charlotte, NC 28205-1030
Phone (980) 302-9820

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Jan 10, 2018 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 10, 2018 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Feb 21, 2022 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 2, 2017 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Feb 21, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Jan 10, 2018 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 10, 2018 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 2, 2017 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

15110 John J Delaney Dr
Ste 200
Charlotte, NC 28277
Phone (704) 302-8100

416 E 36th St
Ste 200
Charlotte, NC 28205
Phone (980) 302-9800

10650 Park Rd
Ste 420
Charlotte, NC 28210
Phone (704) 302-8700

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

441 McAlister Rd
Ste 1200
Lincolnton, NC 28092
Phone (980) 212-6200

332 N Trade St
Ste 2000
Matthews, NC 28105
Phone (704) 302-8500

11304 Hawthorne Dr
Ste 100
Mint Hill, NC 28227
Phone (704) 384-8760

1550 Faulk St
Ste 1500
Monroe, NC 28112
Phone (704) 302-9700

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: nwaltz1036245@direct.novanthealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 4

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": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1295995462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E 36TH ST",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051030",
            "telephone_number": "980-302-9800",
            "fax_number": "980-302-9810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "332 N Trade St",
            "address_2": "Suite 2000",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281051728",
            "country_code": "US",
            "telephone_number": "704-302-8500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 S College St",
            "address_2": "Suite 500",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282022012",
            "country_code": "US",
            "telephone_number": "704-302-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_2": "Suite 420",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-302-8700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15110 John J Delaney Dr",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282773544",
            "country_code": "US",
            "telephone_number": "704-302-8100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11304 Hawthorne Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Mint Hill",
            "state": "NC",
            "postal_code": "282279425",
            "country_code": "US",
            "telephone_number": "704-545-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTZ",
        "first_name": "NICHOLE",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.