Caromont Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CAROMONT MEDICAL GROUP INC

Practice address

112 Woodlawn Rd
Mount Holly, NC 28120-1775

Phone

(704) 827-3575

Fax

(704) 827-0840

NPI assigned

Oct 31, 2007

Organization subpart

No

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

Authorized official

Name

Valinda L Rutledge

Title

President, Ceo

Phone

(704) 834-2133

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CaroMont Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276041600000",
    "number": "1356520951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 WOODLAWN RD",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281201775",
            "telephone_number": "704-827-3575",
            "fax_number": "704-827-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 WOODLAWN RD",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281201775",
            "telephone_number": "704-827-3575",
            "fax_number": "704-827-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROMONT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2010-06-09",
        "status": "A",
        "authorized_official_last_name": "RUTLEDGE",
        "authorized_official_first_name": "VALINDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "704-834-2133"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8903162",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CaroMont Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Justin Busher, LCSWA, PSS, QP
• Nicole M Cady, RD, LDN, CNSC
• Carolina Family Spine Center, PC
• Carolina Speech Academy, PLLC
• Carolinas Physicians Network Inc
• Kelly L. Carpenter, LCSW
• Tomas F Chao, LAT, ATC
• Charleys Drugs & Sundries Inc
• Ashley Chidester
• Marlene King Chisholm, RN

• Family Medicine Physician in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.