NPIMap

Organization Active NPI

Carolinas Medical Center

Doing business as CMC Psychiatry and Behavioral Health

  • Child & Adolescent Psychiatry Physician
  • Charlotte, NC
National Provider Identifier
1356689996
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
CAROLINAS MEDICAL CENTER
Doing business as
CMC Psychiatry and Behavioral Health
Practice address
501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009
Phone
(704) 444-2400
NPI assigned
Jan 16, 2013
Last updated
Mar 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU Primary

Addresses

Primary practice location

501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other practice location 1

2301 US Highway 74 W
RM 1051
Wadesboro, NC 28170-7554
Phone (704) 694-4520

Other practice location 2

16740 Davidson Concord Rd
Davidson, NC 28036-8746
Phone (704) 444-2400

Other practice location 3

706 W King St
Kings Mountain, NC 28086-2708
Phone (980) 487-5470

Other names 1

  • CMC Psychiatry and Behavioral Health Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000116 NC Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 2,635 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20230803001286 FL Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 1 practitioner
Practice locations: Boca Raton, FL

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Part of
Carolinas Mecical Ctr N

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 211

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 211

NPI Registry JSON

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

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1356689996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY RD",
            "address_2": "STE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-444-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 US Highway 74 W",
            "address_2": "RM 1051",
            "address_purpose": "LOCATION",
            "city": "Wadesboro",
            "state": "NC",
            "postal_code": "281707554",
            "country_code": "US",
            "telephone_number": "704-694-4520",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16740 Davidson Concord Rd",
            "address_purpose": "LOCATION",
            "city": "Davidson",
            "state": "NC",
            "postal_code": "280368746",
            "country_code": "US",
            "telephone_number": "704-444-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "706 W King St",
            "address_purpose": "LOCATION",
            "city": "Kings Mountain",
            "state": "NC",
            "postal_code": "280862708",
            "country_code": "US",
            "telephone_number": "980-487-5470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2013-01-16",
        "last_updated": "2023-03-09",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "501 Billingsley Rd",
            "address_2": "Ste B",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282111009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CMC Psychiatry and Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CMC Psychiatry and Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.