Payton Gregory Fennell, D.O
Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Charlotte, NC
NPI 1306906086 · NPPES record last updated Jun 14, 2021
Key facts
- NPI
- 1306906086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 200601317 (NC)
- Practice address
- 4741 Randolph Rd
Charlotte, NC 28211-2919 - Phone
- (704) 365-6730
- Fax
- (704) 365-6731
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 33
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Sports Medicine
- Education
- Philadelphia College of Osteopathic Medicine, 2005
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Novant Health Medical Group, LLC
Comprehab, Inc
Cora South Carolina LLC
Practice addresses (Care Compare)
13245 Reese Blvd W
Suite 100
Huntersville, NC 28078-6390
Phone (704) 316-3142
2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800
851 Heckle Blvd
Rock Hill, SC 29730-2806
Phone (839) 388-0908
Hospital & facility affiliations
- Novant Health Matthews Medical Center
- Novant Health Presbyterian Medical Center
- Novant Health Mint Hill Medical Center
- Novant Health Huntersville Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070720000562 | NC | Practitioner - Sports Medicine |
1153422175 | Reassigns benefits to 4 organizations |
| I20110517000478 | GA | Practitioner - Emergency Medicine |
1153422175 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200601317 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DLP Frye Medical Group LLC | Current |
Accepting new patients | |
| The Carolinas Emergency Group, PLLC | Current |
Accepting new patients | |
| Novant Health Medical Group, LLC | Family Medicine | Current |
Accepting new patients |
| DLP Frye Medical Group LLC | Family Medicine | Current |
Accepting new patients |
| Novant Health Medical Group, LLC | Current |
Accepting new patients | |
| Nes Georgia, Inc. | Current |
Accepting new patients | |
| Nes Georgia Inc | Current |
Accepting new patients | |
| Western Carolina Emergency Physicians, PLLC | Current |
Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Past | Accepting new patients | |
| Serio South Carolina, LLC | Past | Accepting new patients | |
| Dodge County Emergency Physicians LLC | Past | Accepting new patients | |
| Pee Dee Emergency Physicians | Past | Accepting new patients |
Locations
163 S Tallahassee St
Hazlehurst, GA 31539
Phone (912) 375-7781
301 Yadkin St
Albemarle, NC 28001
Phone (704) 984-4000
8045 Providence Rd
Ste 100
Charlotte, NC 28277
Phone (704) 316-1222
4741 Randolph Rd
Ste 100200
Charlotte, NC 28211
Phone (704) 365-6730
4741 Randolph Rd
#100
Charlotte, NC 28211
Phone (704) 365-6730
915 Tate Blvd SE
Ste 182
Hickory, NC 28602
Phone (828) 322-2005
52 12th Ave NE
Hickory, NC 28601
Phone (828) 328-2941
13245 Reese Blvd W
Ste 100
Huntersville, NC 28078
Phone (704) 316-3142
223 Hospital St
Mocksville, NC 27028
Phone (336) 751-8100
600 Hospital Dr
Monroe, NC 28112
Phone (704) 283-3100
288 S Ridgecrest Ave
Rutherfordton, NC 28139
Phone (252) 808-6000
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
- https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
- pfennell886293@direct.novanthealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 200601317 | NC | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 200601317 | NC | Yes |
Addresses
Primary practice location
4741 Randolph Rd
Charlotte, NC 28211-2919
Mailing address
52 12TH Ave NE
Hickory, NC 28601-2798
Phone (828) 485-3004
Other practice location 1
5641 Poplar Tent Rd
Suite 101
Concord, NC 28027-7533
Phone (704) 782-1955
Other practice location 2
52 12th Ave NE
Hickory, NC 28601
Phone (828) 485-3004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306906086 | Medicaid | NC |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pfennell886293@direct.novanthealth.org |
Other providers in Charlotte, NC
- Elizabeth Fenichel
- Tsehaiwork Tesfaye Fenikile
- Carly Fenimore
- Fenix Collective Inc
- Sharon Ann Fenlon I
- Teresa Fatemah Fennell
- Elizabeth Fenner
- Gail Herndon Fennimore
- Alison Mae Fensterer
- Sydney Kay Fenton
All providers in Charlotte, NC · Sports Medicine (Family Medicine) Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.