Individual provider Active NPI

James Lennart Carlson, MD

  • Family Medicine Physician
  • Cerro Gordo, NC
National Provider Identifier
1366545642
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200200010 Issued in NC
Practice address
7490 Andrew Jackson Hwy.SW
Cerro Gordo, NC 28430
Phone
(910) 654-2050
Fax
(910) 654-1258
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200200010 NC Primary

Addresses

Primary practice location

7490 Andrew Jackson Hwy.SW
Cerro Gordo, NC 28430

Mailing address

510 Kingsworth LN SE
Leland, NC 28451-8582
Phone (910) 383-2226

Other identifiers 1

IdentifierTypeStateIssuer
F70725MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
200200010NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chatuge Regional Hospital Inc Past Accepting new patients
G&G Healthcare, PC Family Medicine Past Accepting new patients
Chatuge Regional Hospital Inc Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366545642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 KINGSWORTH LN SE",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284518582",
            "telephone_number": "910-383-2226",
            "fax_number": "910-654-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7490 ANDREW JACKSON HWY.SW",
            "city": "CERRO GORDO",
            "state": "NC",
            "postal_code": "28430",
            "telephone_number": "910-654-2050",
            "fax_number": "910-654-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JAMES",
        "middle_name": "LENNART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200200010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F70725",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cerro Gordo, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.