NPIMap

Organization Active NPI

CMC-Northeast, Inc

  • Pediatric Neurodevelopmental Disabilities Physician
  • Huntersville, NC
National Provider Identifier
1467505016
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
Legal business name
CMC-NORTHEAST, INC
Doing business as
NE Pediatric Neurology, Huntersville
Practice address
16623 Birkdale Pwky
Suite 110, NE Pediatric Neuro, Huntersville
Huntersville, NC 28078
Phone
(704) 987-4277
Fax
(704) 987-5096
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Frieda M Lowder
Title
VP Physician Serv
Phone
(704) 783-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0008X Primary

Addresses

Primary practice location

16623 Birkdale Pwky
Suite 110, NE Pediatric Neuro, Huntersville
Huntersville, NC 28078

Mailing address

16623 Birkdale Pwky
Suite 110, NE Pediatric Neuro, Huntersville
Huntersville, NC 28078
Phone (704) 987-4277

Other identifiers 6

IdentifierTypeStateIssuer
7837542OtherNCAETNA
015Y1OtherNCBCBS GROUP ID
3555573OtherNCMAMSI
5903854MedicaidNC
566000156075OtherNCTRICARE STANDARD, NON NWK
I912OtherNCPARTNERS MEDICARE CHOICE

Other names 1

  • NE Pediatric Neurology, Huntersville Doing business as

National Provider Directory

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

Other organizations with this tax ID 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1467505016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16623 BIRKDALE PWKY",
            "address_2": "SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "28078",
            "telephone_number": "704-987-4277",
            "fax_number": "704-987-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16623 BIRKDALE PWKY",
            "address_2": "SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "28078",
            "telephone_number": "704-987-4277",
            "fax_number": "704-987-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP PHYSICIAN SERV",
        "authorized_official_telephone_number": "704-783-4146"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7837542",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "015Y1",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "3555573",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903854",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE STANDARD, NON NWK",
            "identifier": "566000156075",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE CHOICE",
            "identifier": "I912",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NE Pediatric Neurology, 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 22, 2007; 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.