Organization Active NPI

The Charlotte-Mecklenburg Hospital Authority

Doing business as NorthEast Dermatology - Salisbury

  • Dermatology Physician
  • Salisbury, NC
National Provider Identifier
1497182984
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Doing business as
NorthEast Dermatology - Salisbury
Practice address
340 Jake Alexander Blvd W
Ste 101
Salisbury, NC 28147-1364
Phone
(704) 403-2777
NPI assigned
Sep 30, 2013
Last updated
Jan 5, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

340 Jake Alexander Blvd W
Ste 101
Salisbury, NC 28147-1364

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 1

  • NorthEast Dermatology - Salisbury Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100309000605 NC Part B Supplier - Clinic/Group Practice 2961310685 Receives reassigned benefits from 1,831 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Carolinas Medical Center

Locations

340 Jake Alexander Blvd W
Ste 101
Salisbury, NC 28147
Phone (704) 403-2777

340 Jake Alexander Blvd W
Ste B
Salisbury, NC 28147
Phone (704) 403-2777

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1497182984",
    "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",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 JAKE ALEXANDER BLVD W",
            "address_2": "STE 101",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471364",
            "telephone_number": "704-403-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY",
        "enumeration_date": "2013-09-30",
        "last_updated": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "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"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "340 Jake Alexander Blvd W",
            "address_2": "Ste 101",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281471364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "NorthEast Dermatology - Salisbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.