NPIMap

Organization Active NPI

Caldwell Memorial Hospital, Inc.

Doing business as RiverCrest Medical Park

  • Internal Medicine Physician
  • Lenoir, NC
National Provider Identifier
1417483728
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CALDWELL MEMORIAL HOSPITAL, INC.
Doing business as
RiverCrest Medical Park
Practice address
160 River Bend Drive
Suite a
Lenoir, NC 28630
Phone
(828) 757-5060
Fax
(828) 757-5064
NPI assigned
May 5, 2017
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CALDWELL MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Karen Shadowens
Title
Cfo
Phone
(336) 627-8512

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary
Gastroenterology Physician 207RG0100X
Otolaryngology Physician 207Y00000X

Addresses

Primary practice location

160 River Bend Drive
Suite a
Lenoir, NC 28630

Mailing address

321 Mulberry St SW
Medical Staff Services
Lenoir, NC 28645-5720
Phone (828) 757-5965

Other names 1

  • RiverCrest Medical Park Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000355 NC Part B Supplier - Clinic/Group Practice 5395646970 Receives reassigned benefits from 325 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lenoir, NC; Chapel Hill, NC; Blowing Rock, NC; Granite Falls, NC; Hickory, NC; Hudson, NC

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Part of
Caldwell Memorial Hospi

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1493942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1417483728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 MULBERRY ST SW",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "286455720",
            "telephone_number": "828-757-5965",
            "fax_number": "828-757-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 RIVER BEND DRIVE",
            "address_2": "SUITE A",
            "city": "LENOIR",
            "state": "NC",
            "postal_code": "28630",
            "telephone_number": "828-757-5060",
            "fax_number": "828-757-5064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALDWELL MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALDWELL MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2017-05-05",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "SHADOWENS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "336-627-8512"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RiverCrest Medical Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RiverCrest Medical Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lenoir, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.