NPIMap

Individual provider Active NPI

Andrew J Kapustin, M.D.

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1457311649
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
200500553 Issued in NC
Practice address
3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone
(704) 332-1291
Fax
(704) 332-5206
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 200500553 NC Primary

Addresses

Primary practice location

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211

Mailing address

PO Box 221249
Charlotte, NC 28222-1249
Phone (704) 332-1291

Other identifiers 2

IdentifierTypeStateIssuer
N53005MedicaidSC
5902121MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050805000255 NC Practitioner - Diagnostic Radiology 4981697489 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Harvard Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

Practice addresses (Care Compare)

1500 Matthews Township Pkwy
Matthews, NC 28105-4656
Phone (704) 384-6750

1901 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 316-1400

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-4056

2042 Beverly Dr
Charlotte, NC 28207-2602
Phone (704) 332-1291

2608 Flintgrove Rd
Charlotte, NC 28226-5619
Phone (704) 332-1291

2900 Randolph Rd
Charlotte, NC 28211-1021
Phone (704) 384-7140

3115 Springs Farm LN
Charlotte, NC 28226-0911
Phone (704) 332-1291

3623 Latrobe Dr
Suite 216
Charlotte, NC 28211-2117
Phone (704) 332-1291

511 Queens Rd
Apt 503
Charlotte, NC 28207-1598
Phone (704) 332-1291

653 Concord Rd
Davidson, NC 28036-9033
Phone (704) 332-1291

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
98.89
Improvement activities
40
Cost
72.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
200500553NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mecklenburg Radiology Associates, P.a. Diagnostic Radiology CurrentSince Jul 11, 2005 Accepting new patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Trustees of the University of Pennsylvania Past Accepting new patients
Univ of Penn Community Radiology Diagnostic Radiology Past Accepting new patients

Locations

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone (704) 926-1827

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1457311649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221249",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221249",
            "telephone_number": "704-332-1291",
            "fax_number": "704-332-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR",
            "address_2": "STE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28211",
            "telephone_number": "704-332-1291",
            "fax_number": "704-332-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPUSTIN",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200500553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N53005",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902121",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.