Organization Active NPI

Gestalt Pain Consultants

  • Interventional Pain Medicine Physician
  • Charlotte, NC
National Provider Identifier
1447726989
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GESTALT PAIN CONSULTANTS
Practice address
10450 Park Rd Ste 100
Charlotte, NC 28210-8546
Phone
(704) 526-0091
Fax
(980) 237-6858
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Dr. Adewunmi Akande, MDNPI 1063405306
Title
Owner
Phone
(704) 526-0091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

10450 Park Rd Ste 100
Charlotte, NC 28210-8546

Mailing address

10450 Park Rd Ste 100
Charlotte, NC 28210-8546
Phone (704) 526-0091

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220406000353 NC Part B Supplier - Clinic/Group Practice 8729474424 Receives reassigned benefits from 1 practitioner
Practice locations: Charlotte, NC

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2159317Gestalt Pain Consultants10450 Park Road Suite 100, Charlotte, NC 28210Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory

Locations

10450 Park Rd
Ste 100
Charlotte, NC 28210
Phone (704) 526-0091

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1447726989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 PARK RD STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108546",
            "telephone_number": "704-526-0091",
            "fax_number": "980-237-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 PARK RD STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108546",
            "telephone_number": "704-526-0091",
            "fax_number": "980-237-6858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GESTALT PAIN CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "AKANDE",
        "authorized_official_first_name": "ADEWUNMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-526-0091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 8, 2022; 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.