NPIMap

Organization Active NPI

Ballantyne Family Medicine PC

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1376804971
Registry record updated Feb 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2011-01795 Issued in NC
Legal business name
BALLANTYNE FAMILY MEDICINE PC
Practice address
16147 Lancaster Hwy
Suite 140
Charlotte, NC 28277-4782
Phone
(704) 208-4134
Fax
(704) 248-7845
NPI assigned
May 31, 2012
Last updated
Feb 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2016

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

Authorized official

Name
Dr. Richard T. Wynn, M.D.NPI 1356365480
Title
President
Phone
(704) 208-4134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 2011-01795 NC Primary

Addresses

Primary practice location

16147 Lancaster Hwy
Suite 140
Charlotte, NC 28277-4782

Mailing address

16147 Lancaster Hwy
Suite 140
Charlotte, NC 28277-4782
Phone (704) 208-4134

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1376804971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16147 LANCASTER HWY",
            "address_2": "SUITE 140",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774782",
            "telephone_number": "704-208-4134",
            "fax_number": "704-248-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16147 LANCASTER HWY",
            "address_2": "SUITE 140",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774782",
            "telephone_number": "704-208-4134",
            "fax_number": "704-248-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLANTYNE FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-208-4134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2011-01795",
            "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 Feb 24, 2016; 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.