Individual provider Active NPI

Diane R Merrill, NP

  • Nurse Practitioner
  • Concord, NC
National Provider Identifier
1487767406
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
960021 Issued in NC
Practice address
1090 NE Gateway CT NE
Ste 201
Concord, NC 28025-2414
Phone
(704) 403-7770
NPI assigned
Aug 16, 2006
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 960021 NC Primary

Addresses

Primary practice location

1090 NE Gateway CT NE
Ste 201
Concord, NC 28025-2414

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

200 Medical Park Dr
Ste 230
Concord, NC 28025-2982
Phone (704) 403-1349

Other practice location 2

100 Medical Park Dr
Ste 210
Concord, NC 28025-2948
Phone (704) 403-6100

Other practice location 3

920 Church St N
Concord, NC 28025-2927
Phone (704) 403-1311

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dmerrill96963@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040723000610 NC Practitioner - Nurse Practitioner 5395725907 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Medical Park Dr
Suite 110
Concord, NC 28025-2966
Phone (704) 403-1370

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
960021NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Dec 22, 2015 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 9, 2026 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 11, 2017 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Dec 22, 2015 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 11, 2017 Accepting new patients
Charlotte Medical Clinic Inc Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

1001 Blythe Blvd
Ste 300
Charlotte, NC 28203

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

100 Medical Park Dr
Ste 110
Concord, NC 28025
Phone (704) 403-1370

100 Medical Park Dr
Ste 210
Concord, NC 28025
Phone (704) 403-6100

1085 NE Gateway Ct NE
#200A
Concord, NC 28025
Phone (704) 403-8650

1090 NE Gateway Ct NE
Ste 201
Concord, NC 28025
Phone (704) 403-7770

200 Medical Park Dr
Ste 230
Concord, NC 28025
Phone (704) 403-1349

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

990 Lee Ann Dr NE
Concord, NC 28025
Phone (704) 441-0272

1020 Tree of Life Ln
Cornelius, NC 28031
Phone (704) 801-7330

10545 Blair Rd
Ste 200
Mint Hill, NC 28227
Phone (704) 863-9500

1550 Faulk St
Ste 1500
Monroe, NC 28112
Phone (704) 302-9700

134 Medical Park Rd
Ste 111
Mooresville, NC 28117
Phone (704) 801-9100

Interoperability endpoints

  • Direct secure messaging: dmerrill96963@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 9

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1487767406",
    "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": "1090 NE GATEWAY CT NE",
            "address_2": "STE 201",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252414",
            "telephone_number": "704-403-7770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Medical Park Dr",
            "address_2": "Ste 230",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252982",
            "country_code": "US",
            "telephone_number": "704-403-1349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 210",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252948",
            "country_code": "US",
            "telephone_number": "704-403-6100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 Church St N",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252927",
            "country_code": "US",
            "telephone_number": "704-403-1311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "DIANE",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "960021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmerrill96963@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1090 NE Gateway Ct NE",
            "address_2": "Ste 201",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.