NPIMap

Organization Active NPI

Kellogg Medical PLLC

  • Addiction Medicine (Family Medicine) Physician
  • Charlotte, NC
National Provider Identifier
1528699089
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
KELLOGG MEDICAL PLLC
Practice address
10352 Park Rd
Charlotte, NC 28210-8401
Phone
(704) 288-1097
NPI assigned
Feb 3, 2020
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Alan Goodstat, LCSWNPI 1306455316
Title
Coo
Phone
(704) 288-1097

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

10352 Park Rd
Charlotte, NC 28210-8401

Mailing address

10352 Park Rd
Charlotte, NC 28210-8401
Phone (704) 288-1097

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address admissions@theblanchardinstitute.com Direct The Blanchard Institute
Direct Messaging Address admissions@theblanchardinstitute.com Direct The Blanchard Institute

National Provider Directory

National Provider Directory

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": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1528699089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10352 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108401",
            "telephone_number": "704-288-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10352 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108401",
            "telephone_number": "704-288-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLOGG MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-03",
        "last_updated": "2023-11-27",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "GOODSTAT",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-288-1097",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admissions@theblanchardinstitute.com",
            "affiliation": "Y",
            "endpointDescription": "Facility",
            "affiliationName": "The Blanchard Institute",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "10352 Park Rd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282108401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admissions@theblanchardinstitute.com",
            "affiliation": "Y",
            "endpointDescription": "Facility",
            "affiliationName": "The Blanchard Institute",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "10352 Park Rd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282108401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 27, 2023; 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.