Central Carolina Dermatology Clinic, Inc

Primary specialty

Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X

License

34D0238143 Issued in NC

Legal business name

CENTRAL CAROLINA DERMATOLOGY CLINIC, INC

Practice address

4010 Mendenhall Oaks Pkwy
High Point, NC 27265-8076

Phone

(336) 887-3195

Fax

(336) 887-3194

NPI assigned

Jun 27, 2005

Organization subpart

No

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

Authorized official

Name

Kristine N Kearns

Title

Practice Administrator

Phone

(336) 934-5070

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua S Butler, MD

  • Dermatology Physician
  • High Point, NC
  • NPI 1225272040
  Medicare reassignment Care Compare group NPD
• Kyle H Flores, MD

  • MOHS-Micrographic Surgery Physician
  • High Point, NC
  • NPI 1467816462

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Carlin Bullard Hollar, M.D.

  • Dermatology Physician
  • High Point, NC
  • NPI 1982766309
  Medicare reassignment Care Compare group NPD
• Robert Tad Migliardi, MD

  • Dermatology Physician
  • High Point, NC
  • NPI 1659375160
  Medicare reassignment Care Compare group NPD
• Edward Shiang-Lin Smith, MD

  • Dermatology Physician
  • High Point, NC
  • NPI 1679577100
  Medicare reassignment Care Compare group NPD
• Quinn Thibodeaux, M.D.

  • Dermatopathology Physician
  • High Point, NC
  • NPI 1245771575

  Dermatology

  Medicare reassignment Care Compare group NPD
• Elyshia Michelle Warden, PA-C

  • Medical Physician Assistant
  • High Point, NC
  • NPI 1568572279
  Medicare reassignment Care Compare group
• Cynthia Chen, MD

  • Dermatology Physician
  • High Point, NC
  • NPI 1164985529
  Medicare reassignment NPD

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1316943145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 MENDENHALL OAKS PKWY",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272658076",
            "telephone_number": "336-887-3195",
            "fax_number": "336-887-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 MENDENHALL OAKS PKWY",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272658076",
            "telephone_number": "336-887-3195",
            "fax_number": "336-887-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CAROLINA DERMATOLOGY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "KEARNS",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "336-934-5070"
    },
    "taxonomies": [
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "NC",
            "license": "34D0238143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD4358",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "230129",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901788",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria J Causey, CRNA
• Percy Thomas Causey Jr., MD
• Julina Cefaly
• Center for Holistic Healing PC
• Central Carolina Associates in Optometry PA
• Central Carolina Psychotherapy, PLLC
• Century Medical Supplies, Inc.
• Kelly Ann Chaballa
• Nicolai Chalfa, MD
• Venkata Ramana Challa, MD

• Clinical & Laboratory Dermatological Immunology Physician in High Point, NC
• Providers in High Point, NC by specialty
• Clinical & Laboratory Dermatological Immunology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.