NPIMap

Organization Active NPI

Eastover Psychological & Psychiatric Group, PA

  • Psychiatry Physician
  • Charlotte, NC
National Provider Identifier
1366476681
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, PA
Practice address
3303 Latrobe Dr
Charlotte, NC 28211-4851
Phone
(704) 362-2663
Fax
(704) 362-2836
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Authorized official

Name
John Edward Humphrey, M.D.
Title
President
Phone
(704) 362-2663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3303 Latrobe Dr
Charlotte, NC 28211-4851

Mailing address

3303 Latrobe Dr
Charlotte, NC 28211-4851
Phone (704) 362-2663

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001652 NC Part B Supplier - Clinic/Group Practice 4880595933 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

3303 Latrobe Dr
Charlotte, NC 28211
Phone (704) 362-2663

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304294400000",
    "number": "1366476681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 LATROBE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114851",
            "telephone_number": "704-362-2663",
            "fax_number": "704-362-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 LATROBE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114851",
            "telephone_number": "704-362-2663",
            "fax_number": "704-362-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTOVER PSYCHOLOGICAL & PSYCHIATRIC GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2011-05-02",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-362-2663",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 2, 2011; 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.