Individual provider Active NPI

Elmer Stamper Jr., PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1467595496
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
100823 Issued in NC
Practice address
5727 Prosperity Crossing Dr
Ste 1100
Charlotte, NC 28269-2206
Phone
(704) 863-9930
NPI assigned
Feb 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2072 SC
Physician Assistant 363A00000X 100823 NC Primary

Addresses

Primary practice location

5727 Prosperity Crossing Dr
Ste 1100
Charlotte, NC 28269-2206

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

332 N Trade St
Ste 1100
Matthews, NC 28105-1728
Phone (704) 512-6850

Other practice location 2

10210 Couloak Dr
Ste E
Charlotte, NC 28216-7679
Phone (704) 801-2000

Other practice location 3

5717 Albemarle Rd
Charlotte, NC 28212-1634
Phone (704) 563-2150

Other practice location 4

7810 Providence Rd
Ste 102
Charlotte, NC 28226-2954
Phone (704) 543-6636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2072SCMDProfessional Counselor
100823NCMDPhysician Assistant
PA2072SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina Em-I Medical Services PC Physician Assistant Past Accepting new patients
Fox Mountain Emergency Physicians Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1467595496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5727 PROSPERITY CROSSING DR",
            "address_2": "STE 1100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282692206",
            "telephone_number": "704-863-9930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "332 N Trade St",
            "address_2": "Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281051728",
            "country_code": "US",
            "telephone_number": "704-512-6850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10210 Couloak Dr",
            "address_2": "Ste E",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282167679",
            "country_code": "US",
            "telephone_number": "704-801-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5717 Albemarle Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282121634",
            "country_code": "US",
            "telephone_number": "704-563-2150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7810 Providence Rd",
            "address_2": "Ste 102",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282262954",
            "country_code": "US",
            "telephone_number": "704-543-6636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAMPER",
        "first_name": "ELMER",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "PA2072",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "100823",
            "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 Dec 20, 2019; 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.