NPIMap

Organization Active NPI

CMC-Northeast, Inc.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Huntersville, NC
National Provider Identifier
1457557795
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
Legal business name
CMC-NORTHEAST, INC.
Doing business as
CAROLINAS PEDIATRIC NEUROLOGY CARE - HUNTERSVILLE
Practice address
9625 Northcross Center CT
Suite 102-B
Huntersville, NC 28078-7348
Phone
(704) 801-1240
Fax
(704) 801-1241
NPI assigned
Jun 25, 2007
Organization subpart
Yes
Parent organization
CMC-NORTHEAST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Authorized official

Name
Frieda M Lowder
Title
VP
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0402X Primary

Addresses

Primary practice location

9625 Northcross Center CT
Suite 102-B
Huntersville, NC 28078-7348

Mailing address

9625 Northcross Center CT
Suite 102-B
Huntersville, NC 28078-7348
Phone (704) 801-1240

Other identifiers 7

IdentifierTypeStateIssuer
5906850MedicaidNC
NPB455MedicaidSC
DF8926OtherNCRAILROAD MEDICARE PTAN
015Y1OtherNCBCBS
019FGOtherNCBCBS EFF 7-1-07
5914183MedicaidNC
355573OtherNCMAMSI

Other names 1

  • CAROLINAS PEDIATRIC NEUROLOGY CARE - HUNTERSVILLE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC Northeast44 organizations share this tax ID, including this one
Part of
CMC Northeast

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

9625 Northcross Center Ct
Ste 102B
Huntersville, NC 28078
Phone (704) 801-1240

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1457557795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9625 NORTHCROSS CENTER CT",
            "address_2": "SUITE 102-B",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787348",
            "telephone_number": "704-801-1240",
            "fax_number": "704-801-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 NORTHCROSS CENTER CT",
            "address_2": "SUITE 102-B",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787348",
            "telephone_number": "704-801-1240",
            "fax_number": "704-801-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2007-06-25",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906850",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB455",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DF8926",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "015Y1",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EFF 7-1-07",
            "identifier": "019FG",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914183",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "355573",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAROLINAS PEDIATRIC NEUROLOGY CARE - HUNTERSVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.