Keri Anne Squittieri, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0010-03191 Issued in NC

Practice address

3006 Baucom Rd
Charlotte, NC 28269-6762

Phone

(704) 596-1787

Fax

(704) 596-6230

NPI assigned

Oct 20, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Care of Charlotte PAGroup PAC ID 7911906151, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Dermatology Care of Charlotte, PA

  • Dermatology Physician
  • Charlotte, NC
  • NPI 1639195126
  Medicare reassignment Care Compare group
• Charlotte Dermatopathology, Inc

  • Clinical Medical Laboratory
  • Charlotte, NC
  • NPI 1558515965
  NPD (past)

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1366727497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17039 KENTON DR",
            "address_2": "STE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280315776",
            "telephone_number": "704-596-1787",
            "fax_number": "704-596-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3006 BAUCOM RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282696762",
            "telephone_number": "704-596-1787",
            "fax_number": "704-596-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUITTIERI",
        "first_name": "KERI",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-20",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-03191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Crutchfield Squires, M.D.
• Kimberly S Squires, FNP-C; PMHNP-BC
• Malcolm Hart Squires III, MD
• Rebekah Squires, PHD
• Harley Squittieri
• Jacqueline Annette Sroka, NP-C
• Oliver Casper Sroka, MD
• SSC Charlotte Operating Company LLC
• SSC Charlotte Shamrock Operating Company LLC
• SSMH Services LLC

• Medical Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.