NPIMap

Organization Active NPI

CMC-Northeast, Inc.

  • Pediatric Critical Care Medicine Physician
  • Huntersville, NC
National Provider Identifier
1386840627
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
Legal business name
CMC-NORTHEAST, INC.
Doing business as
CAROLINA PEDIATRIC SURGERY - HUNTERSVILLE
Practice address
9625 Northcross Center CT
Suite 102-a
Huntersville, NC 28078-7348
Phone
(704) 801-1240
Fax
(704) 801-1241
NPI assigned
Jun 25, 2007
Organization subpart
Yes
Parent organization
CMC-NORTHEAST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Authorized official

Name
Frieda M Lowder
Title
VP Physician Services
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0203X Primary

Addresses

Primary practice location

9625 Northcross Center CT
Suite 102-a
Huntersville, NC 28078-7348

Mailing address

9625 Northcross Center CT
Suite 102-a
Huntersville, NC 28078-7348
Phone (704) 801-1240

Other identifiers 6

IdentifierTypeStateIssuer
019FNOtherNCBCBS EFF 7-1-07
QPB706MedicaidSC
5914359OtherNCMEDICAID, GROUP, EFF 5/1/09
017CPOtherNCBCBS EFF PRIOR TO 7-1-07
355573OtherNCMAMSI
5906850MedicaidNC

Other names 1

  • CAROLINA PEDIATRIC SURGERY - HUNTERSVILLE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC Northeast44 organizations share this tax ID, including this one
Part of
CMC Northeast

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

9625 Northcross Center Ct
Ste 102A
Huntersville, NC 28078
Phone (704) 801-1240

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1386840627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9625 NORTHCROSS CENTER CT",
            "address_2": "SUITE 102-A",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787348",
            "telephone_number": "704-801-1240",
            "fax_number": "704-801-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 NORTHCROSS CENTER CT",
            "address_2": "SUITE 102-A",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787348",
            "telephone_number": "704-801-1240",
            "fax_number": "704-801-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2007-06-25",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EFF 7-1-07",
            "identifier": "019FN",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "QPB706",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID, GROUP, EFF 5/1/09",
            "identifier": "5914359",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EFF PRIOR TO 7-1-07",
            "identifier": "017CP",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "355573",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906850",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAROLINA PEDIATRIC SURGERY - HUNTERSVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.