NPIMap

Organization Active NPI

Southeast Radiation Oncology Group, P.a.

  • Radiation Oncology Physician
  • Charlotte, NC
National Provider Identifier
1568400109
Registry record updated Jan 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
SOUTHEAST RADIATION ONCOLOGY GROUP, P.A.
Practice address
200 Queens Rd
Suite 400
Charlotte, NC 28204-3252
Phone
(704) 333-7376
Fax
(704) 333-3397
NPI assigned
Jun 4, 2006
Last updated
Jan 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2010

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

Authorized official

Name
Paul A Williams, M.S.P.H.
Title
Administrator
Phone
(704) 333-7376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X Primary

Addresses

Primary practice location

200 Queens Rd
Suite 400
Charlotte, NC 28204-3252

Mailing address

200 Queens Rd
Suite 400
Charlotte, NC 28204-3252
Phone (704) 333-7376

Other identifiers 4

IdentifierTypeStateIssuer
NPA534MedicaidSC
131977OtherUNITED HEALTHCARE
01351OtherNCBLUE CROSS
8901351MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000049 NC Part B Supplier - Clinic/Group Practice 1254233950 Receives reassigned benefits from 68 practitioners
Practice locations: Albemarle, NC; Summerville, SC; Shelby, NC; Salisbury, NC; Monroe, NC; Hickory, NC; Concord, NC; Charlotte, NC…

National Provider Directory

National Provider Directory

Locations

182 Virginia St
Boone, NC 28607
Phone (828) 262-4342

1021 E Morehead St
Charlotte, NC 28204

1021 Morehead Medical Dr
Ste 100
Charlotte, NC 28204

125 Queens Rd
Ste 150
Charlotte, NC 28204
Phone (980) 302-6144

10030 Gilead Rd
Ste B120
Huntersville, NC 28078
Phone (704) 316-6630

170 Medical Park Rd
Ste 100
Mooresville, NC 28117
Phone (704) 235-2580

229 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

631 Mocksville Ave
Salisbury, NC 28144

631 Mocksville Ave
#1010
Salisbury, NC 28144
Phone (704) 210-6870

Practitioners & affiliated clinicians

Practitioners 69

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.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264464000000",
    "number": "1568400109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043252",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 QUEENS RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043252",
            "telephone_number": "704-333-7376",
            "fax_number": "704-333-3397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST RADIATION ONCOLOGY GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2010-01-26",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-333-7376",
        "authorized_official_credential": "M.S.P.H."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPA534",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "131977",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "01351",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901351",
            "state": "NC"
        }
    ],
    "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 Jan 26, 2010; 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.