NPIMap

Organization Active NPI

Carolina Medicorp Enterprises,Inc

Doing business as Novant Health Urgent Care & Occupational Medicine

  • Emergency Medicine Physician
  • Matthews, NC
National Provider Identifier
1346529500
Registry record updated Oct 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
CAROLINA MEDICORP ENTERPRISES,INC
Doing business as
Novant Health Urgent Care & Occupational Medicine
Practice address
9600 E Independence Blvd Ste 170
Matthews, NC 28105-4628
Phone
(704) 384-8441
Fax
(704) 384-8442
NPI assigned
Aug 5, 2011
Last updated
Oct 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2017

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

Authorized official

Name
Geoffrey Gardner
Title
VP Finance
Phone
(704) 384-9890

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X

Addresses

Primary practice location

9600 E Independence Blvd Ste 170
Matthews, NC 28105-4628

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (704) 384-8441

Other names 1

  • Novant Health Urgent Care & Occupational Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000190 NC Part B Supplier - Clinic/Group Practice 0648174904 Receives reassigned benefits from 249 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cornelius, NC; Greensboro, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Kernersville, NC; Lexington, NC; Matthews, NC…

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1003393Novant Health Gohealth Urgent Care9600 E Independence Boulevard, Ste B, Matthews, NC 28105Certificate of waiverJan 4, 2027

National Provider Directory

National Provider Directory

Locations

9600 E Independence Blvd
Ste 170
Matthews, NC 28105
Phone (704) 384-8441

NPI Registry JSON

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506902400000",
    "number": "1346529500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "704-384-8441",
            "fax_number": "704-384-8442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 E INDEPENDENCE BLVD STE 170",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281054628",
            "telephone_number": "704-384-8441",
            "fax_number": "704-384-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA MEDICORP ENTERPRISES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2017-10-02",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "704-384-9890"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Urgent Care & Occupational Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; 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.