Stephen James Ezzo, M.D,

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

31983 Issued in NC

Practice address

1401 Matthews Township Pkwy
Suite 100
Matthews, NC 28105-5402

Phone

(704) 384-1080

Fax

(704) 384-1122

NPI assigned

Feb 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sezzo14523@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group LLC

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1922721141
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1386616118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1080",
            "fax_number": "704-384-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055402",
            "telephone_number": "704-384-1080",
            "fax_number": "704-384-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZZO",
        "first_name": "STEPHEN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "31983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N31983",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8930983",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sezzo14523@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1401 Matthews Township Pkwy",
            "address_2": "Suite 100",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281055402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Casey R Eutsler, MS, OTR/L
• Courtney Manion Evangelista, PA-C
• Everest Chiropractic and Wellness, PA
• Donna L. Everett, PTA
• Shelley Jane Everts, FNP
• Derek Farmen
• Edith Ann Farr, APRN
• Sandra R Farrelly, RN
• Olukayode Fasuba
• Zayd Fattah

• Pediatrics Physician in Matthews, NC
• Providers in Matthews, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.