Carolina Pediatric Center, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CAROLINA PEDIATRIC CENTER, PLLC

Practice address

239 Wilmot Dr Ste a
Gastonia, NC 28054-4048

Phone

(704) 864-0303

Fax

(704) 864-6070

NPI assigned

Jul 25, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Olivia B Mijumbi, MDNPI 1144208000

Title

Medical Director

Phone

(704) 864-0303

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

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.

• Olivia Bridget Mijumbi, MD

  • Pediatrics Physician
  • Gastonia, NC
  • NPI 1144208000
  NPD Authorized official

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1538501903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550818",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280550818",
            "telephone_number": "704-864-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 WILMOT DR STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544048",
            "telephone_number": "704-864-0303",
            "fax_number": "704-864-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PEDIATRIC CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-25",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "MIJUMBI",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "704-864-0303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2900124",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9554744001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9259849",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "12-01098",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1322Y",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891322Y",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "A8708",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Carolina Orthopaedic & Sports Medicine Center, P.a.
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• Carolina Physical Medicine & Rehabilitation, PC
• Carolina Spine, Pain and Rehabilitation PLLC
• Carolina Surgery PA
• Carolina Therapeutic Services Community Development Inc
• Carolina Therapeutic Services, Inc

• Pediatrics Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.