NPIMap

Organization Active NPI

Charlotte Eye Ear Nose & Throat Associates, PA

  • Ophthalmology Physician
  • Pineville, NC
National Provider Identifier
1396930442
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CHARLOTTE EYE EAR NOSE & THROAT ASSOCIATES, PA
Practice address
10405 Centrum Pkwy
Pineville, NC 28134-8825
Phone
(704) 295-3650
Fax
(704) 295-3666
NPI assigned
Sep 12, 2007
Last updated
Apr 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Authorized official

Name
Jag S Gill, SCD
Title
Ceo
Phone
(704) 295-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary
Otolaryngology Physician 207Y00000X

Addresses

Primary practice location

10405 Centrum Pkwy
Pineville, NC 28134-8825

Mailing address

6035 Fairview Rd
Charlotte, NC 28210-3256
Phone (704) 295-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000519 NC Part B Supplier - Clinic/Group Practice 0446155451 Receives reassigned benefits from 170 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monroe, NC; Statesville, NC; Salisbury, NC; Pineville, NC; Mooresville, NC; Matthews, NC; Huntersville, NC; Charlotte, NC…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

10512 Park Rd
Ste 200
Charlotte, NC 28210
Phone (704) 295-3650

Practitioners & affiliated clinicians

Practitioners 54

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.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1396930442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000",
            "fax_number": "704-838-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10405 CENTRUM PKWY",
            "city": "PINEVILLE",
            "state": "NC",
            "postal_code": "281348825",
            "telephone_number": "704-295-3650",
            "fax_number": "704-295-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE EYE EAR NOSE & THROAT ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "JAG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-295-3000",
        "authorized_official_credential": "SCD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pineville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.