Centerwell Senior Primary Care (NC), P.C.
Organization Active NPI Internal Medicine Physician · Burlington, NC
NPI 1497575997 · NPPES record last updated Jan 24, 2025
Key facts
- NPI
- 1497575997
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (NC), P.C.
- Practice address
- 378 Harden St
Burlington, NC 27215-7516 - Phone
- (336) 698-3500
- NPI assigned
- Oct 10, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE (NC), P.C.
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 6
Member organizations 2
Practitioners 49
-
Chelsa Boswell, NP
-
Heidi Suzanne Cammer, FNP
-
Jerell Diego Chua, MPH, D.O.
-
Jaicie N Congress, FNP-C
-
Debra Cooper, DO
-
Deneda Thomas Daye, FNP
-
Sulabha Godbole Gupta, M.D.
-
Jalecia Maria Jones, FNP-BC
-
Christel N Keisler, M.D.
-
Miesha Kindell, ARNP
-
Haresh Kumar, MD
-
Marion Z Lewis, AGNP
-
Kavithamani Mallan, FNP
-
Elie Osta, MD
-
Kusum Paudel, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2271545 | Centerwell Senior Primary Care(NC), PC -Burlington | Certificate of waiver | Nov 2, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171016002152 | NC | Part B Supplier - Clinic/Group Practice | 2264708486 |
Receives reassigned benefits from 65 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Burlington, NC; Gastonia, NC; Greensboro, NC; Winston Salem, NC |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care NC PC
- Part of
- Centerwell Senior Primary Care NC PC
Locations
3512 Wilkinson Blvd
Charlotte, NC 28208
2703 W Gate City Blvd
Ste J
Greensboro, NC 27403
Phone (336) 790-5400
3409 Thomasville Rd
Winston Salem, NC 27107
Phone (743) 229-3300
1401 Sam Rittenberg Blvd
Ste 6
Charleston, SC 29407
Phone (843) 973-5393
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X | |||
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
378 Harden St
Burlington, NC 27215-7516
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Other names
- CenterWell Senior Primary Care (NC), P.C. - Burlington
Other providers in Burlington, NC
- Steven Duane Cecil
- Cedars Dda Group Home
- Ceesons of Change
- Center for Genetic Services, Inc
- Center for Orthotic and Prosthetic Care of North Carolina Inc
- Central Carolina Gynecology & Urogynecology
- Central Carolina Hematology Oncology Associates PLLC
- Central Carolina Kidney Associates PA
- Central State of the Carolinas, Inc.
- CG Health Consulting PLLC
All providers in Burlington, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.