Community Medical, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COMMUNITY MEDICAL, P.A.

Practice address

520 W Main St
Marshville, NC 28103-1197

Phone

(704) 624-3388

Fax

(704) 624-3390

NPI assigned

Jul 27, 2007

Last updated

Apr 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Brandi Selina Queen, FNPNPI 1558670604

Title

President

Phone

(704) 292-0708

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27335/brand/1/csg/1/fhir/r4

Practitioners 3

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.

• Brandi Selina Queen, FNP

  • Family Nurse Practitioner
  • Marshville, NC
  • NPI 1558670604
  Medicare reassignment Care Compare group NPD Authorized official
• Jason R Ambrose, M.D.

  • Family Medicine Physician
  • Wendell, NC
  • NPI 1538164074
  Medicare reassignment Care Compare group NPD
• Tammy Lannette Myrick Carpenter, FNP-BC

  • Family Nurse Practitioner
  • Marshville, NC
  • NPI 1063106284
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1396935193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W MAIN ST",
            "city": "MARSHVILLE",
            "state": "NC",
            "postal_code": "281031197",
            "telephone_number": "704-624-3388",
            "fax_number": "704-624-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W MAIN ST",
            "city": "MARSHVILLE",
            "state": "NC",
            "postal_code": "281031197",
            "telephone_number": "704-624-3388",
            "fax_number": "704-624-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-27",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "SELINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-292-0708",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "32725",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0132J",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890132J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenton Bundrick, D.D.S.
• Charlitta Estie Burruss, SOCIAL WORKER
• Carolina Behavioral Consulting LLC. (Carolina Behavioral)
• Carolina Physical Rehabilitation Services, Inc.
• Nicole Craven Clark, OTR/L
• Michael Covert
• Hannah Blair Davis, DMD
• Adjara Latifa Dembele
• Discovery ABA
• Lauren Duke, PHARMD

• Family Medicine Physician in Marshville, NC
• Providers in Marshville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.