Active NPI
Stacy Elizabeth Carlson
- Primary Care Nurse Practitioner
- Charlotte, NC
National Provider Identifier
1568085124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- 5016676
- Practice address
- 10620 Park Rd Ste 202
Charlotte, NC 28210-0106 - Phone
- (844) 235-6999
- NPI assigned
- May 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Primary Care Nurse Practitioner | 363LP2300X | 5016676 | NC | Primary |
Addresses
Primary practice location
10620 Park Rd Ste 202
Charlotte, NC 28210-0106
Mailing address
325 Old Stancil Rd
Kenly, NC 27542-5011
Other practice location 1
600 Moye Blvd
Greenville, NC 27834-4300
Phone (252) 744-6478
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221108001071 | NC | Practitioner - Nurse Practitioner | 1951778729 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
10620 Park Rd
Suite 202
Charlotte, NC 28210-0106
Phone (704) 667-0920
Hospital & facility affiliations
- Carolinas Medical Center/Behav Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5016676 | NC | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Physicians Network Inc | Current | Accepting new patients | |
| Carolinas Physicians Network Inc | Current | Accepting new patients | |
| Carolinas Physicians Network, Inc | Current | Accepting new patients |
Locations
10620 Park Rd
Ste 202
Charlotte, NC 28210
Phone (704) 512-3988
14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650
14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070
Interoperability endpoints
- scarlson3009318@carolinashealthcaresystem.direct-ci.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endocrinology, Diabetes & Metabolism Physician
- Charlotte, NC
- NPI 1437038544
-
- Family Medicine Physician
- Charlotte, NC
- NPI 1578939914
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Charlotte, NC
- NPI 1720029705
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748995200000",
"number": "1568085124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 OLD STANCIL RD",
"city": "KENLY",
"state": "NC",
"postal_code": "275425011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10620 PARK RD STE 202",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282100106",
"telephone_number": "844-235-6999"
}
],
"practiceLocations": [
{
"address_1": "600 Moye Blvd",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "NC",
"postal_code": "278344300",
"country_code": "US",
"telephone_number": "252-744-6478",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARLSON",
"first_name": "STACY",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-18",
"last_updated": "2025-06-04",
"certification_date": "2025-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "NC",
"license": "5016676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.