NPIMap

Individual provider Active NPI

Michael Andrianos Thomopoulos, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1356852446
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-07748 Issued in NC
Practice address
125 Queens Rd Ste 430
Charlotte, NC 28204-3215
Phone
(980) 302-6300
Fax
(980) 302-6305
NPI assigned
Oct 17, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 085-006277 IL
Physician Assistant 363A00000X 0010-07748 NC Primary

Addresses

Primary practice location

125 Queens Rd Ste 430
Charlotte, NC 28204-3215

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mthomopoulos721278@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190729000916 NC Practitioner - Physician Assistant 8123354156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Presbyterian HospitalGroup PAC ID 1153231907, 412 clinicians

Practice addresses (Care Compare)

125 Queens Rd
Charlotte, NC 28204-3215

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-9073

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-006277ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Presbyterian Hospital CurrentSince Oct 4, 2020 Accepting new patients
The Presbyterian Hospital CurrentSince Oct 4, 2020 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

125 Queens Rd
Ste 430
Charlotte, NC 28204
Phone (980) 302-6300

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1356852446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 QUEENS RD STE 430",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043215",
            "telephone_number": "980-302-6300",
            "fax_number": "980-302-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMOPOULOS",
        "first_name": "MICHAEL",
        "middle_name": "ANDRIANOS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-17",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-006277",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mthomopoulos721278@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "125 Queens Rd Ste 430",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.