NPIMap

Organization Active NPI

Premise Health of North Carolina Medical, P.C

  • Multi-Specialty Clinic/Center
  • Mount Holly, NC
National Provider Identifier
1457026601
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Doing business as
DTNA - Mt. Holly
Practice address
1800 N Main St
Mount Holly, NC 28120-9141
Phone
(704) 822-7301
Fax
(704) 822-7488
NPI assigned
Aug 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Jon Leizman, MD
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1800 N Main St
Mount Holly, NC 28120-9141

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 1

  • DTNA - Mt. Holly Doing business as

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
34D2038722Premise Health of North Carolina Medical, PC1800 N Main Street, Mount Holly, NC 28120Certificate of waiverMar 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of North Carolina Medical PC54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1800 N Main St
Mount Holly, NC 28120
Phone (704) 822-7301

NPI Registry JSON

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1457026601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 N MAIN ST",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281209141",
            "telephone_number": "704-822-7301",
            "fax_number": "704-822-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DTNA - Mt. Holly",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DTNA - Mt. Holly",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Holly, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.