Individual provider Active NPI

Ellen Satterwhite Davis, MD

  • Pediatrics Physician
  • Gastonia, NC
National Provider Identifier
1366439093
Registry record updated Dec 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
9800835 Issued in NC
Practice address
705 Summit Crossing PL
Suite 150
Gastonia, NC 28054-2137
Phone
(704) 671-6300
Fax
(704) 671-6307
NPI assigned
Sep 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 9800835 NC Primary

Addresses

Primary practice location

705 Summit Crossing PL
Suite 150
Gastonia, NC 28054-2137

Mailing address

705 Summit Crossing PL
Suite 150
Gastonia, NC 28054-2137
Phone (704) 671-6300

Other identifiers 2

IdentifierTypeStateIssuer
N00835MedicaidSC
8911666MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080516000247 NC Practitioner - Pediatric Medicine 1254400245 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9800835NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Caromont Medical Group Inc CurrentSince Apr 6, 2011 Accepting new patients
Caromont Medical Group Inc Pediatrics Current Accepting new patients
Caromont Medical Group, Inc. Pediatrics CurrentSince Apr 6, 2011 Accepting new patients

Locations

705 Summit Crossing Pl
Ste 150
Gastonia, NC 28054
Phone (704) 671-5300

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

2240 Remount Rd
Gastonia, NC 28054
Phone (704) 671-5311

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388448000000",
    "number": "1366439093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 SUMMIT CROSSING PL",
            "address_2": "SUITE 150",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542137",
            "telephone_number": "704-671-6300",
            "fax_number": "704-671-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SUMMIT CROSSING PL",
            "address_2": "SUITE 150",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542137",
            "telephone_number": "704-671-6300",
            "fax_number": "704-671-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ELLEN",
        "middle_name": "SATTERWHITE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2013-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "9800835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00835",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8911666",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.