Active NPI
Caromont Medical Group Inc
- Family Medicine Physician
- Charlotte, NC
National Provider Identifier
1447598701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- CAROMONT MEDICAL GROUP INC
- Practice address
- 14035 Grandiflora Drive
Suite a
Charlotte, NC 28278-8456 - Phone
- (704) 295-9044
- Fax
- (704) 295-9046
- NPI assigned
- Jan 22, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randall L Kelley
- Title
- President, Ceo
- Phone
- (704) 834-2133
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
14035 Grandiflora Drive
Suite a
Charlotte, NC 28278-8456
Mailing address
14035 Grandiflora Drive
Suite a
Charlotte, NC 28278-8456
Phone (704) 295-9044
Other names 1
- CaroMont Urgent Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031201000070 | NC | Part B Supplier - Clinic/Group Practice | 3577476258 |
Receives reassigned benefits from 760 practitioners This NPI is an additional NPI on the enrollment Practice locations: Gastonia, NC; Kings Mountain, NC; Lenoir, NC; McAdenville, NC; Morganton, NC; Shelby, NC; Stanley, NC; Belmont, NC… |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Kings Mountain, NC
- NPI 1841257540
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1358899200000",
"number": "1447598701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14035 GRANDIFLORA DRIVE",
"address_2": "SUITE A",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282788456",
"telephone_number": "704-295-9044",
"fax_number": "704-295-9046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14035 GRANDIFLORA DRIVE",
"address_2": "SUITE A",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282788456",
"telephone_number": "704-295-9044",
"fax_number": "704-295-9046"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROMONT MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-01-22",
"last_updated": "2013-01-23",
"status": "A",
"authorized_official_last_name": "KELLEY",
"authorized_official_first_name": "RANDALL",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT, CEO",
"authorized_official_telephone_number": "704-834-2133"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CaroMont Urgent Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.