NPIMap

Organization Active NPI

Carolinas Medical Center-Northeast

Doing business as Development & Behavioral Pediatrics of the Carolina's

  • Developmental - Behavioral Pediatrics Physician
  • Concord, NC
National Provider Identifier
1568424547
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
CAROLINAS MEDICAL CENTER-NORTHEAST
Doing business as
Development & Behavioral Pediatrics of the Carolina's
Practice address
301 Medical Park Dr
Suite 202B
Concord, NC 28025-2981
Phone
(704) 403-2626
Fax
(704) 784-8615
NPI assigned
Apr 5, 2006
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTER-NORTHEASTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

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

Authorized official

Name
Mrs. Frieda M Lowder
Title
VP Physician Services
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0006X Primary

Addresses

Primary practice location

301 Medical Park Dr
Suite 202B
Concord, NC 28025-2981

Mailing address

301 Medical Park Dr
Suite 202B
Concord, NC 28025-2981
Phone (704) 403-2626

Other identifiers 6

IdentifierTypeStateIssuer
016GNOtherNCBCBS GROUP ID
QPB658OtherSCS.C. MEDICAID
396408OtherNCMAMSI GROUP NO
89135FEMedicaidNC
561878722001OtherNCTRICARE STANDARD, NON NWK
DF8926OtherNCRAILROAD MEDICARE PTAN

Other names 1

  • Development & Behavioral Pediatrics of the Carolina's Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC RX Pavilion44 organizations share this tax ID, including this one
Part of
CMC RX Pavilion

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

4501 Cameron Valley Pkwy
Ste 301
Charlotte, NC 28211

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1568424547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MEDICAL PARK DR",
            "address_2": "SUITE 202B",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252981",
            "telephone_number": "704-403-2626",
            "fax_number": "704-784-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MEDICAL PARK DR",
            "address_2": "SUITE 202B",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252981",
            "telephone_number": "704-403-2626",
            "fax_number": "704-784-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "enumeration_date": "2006-04-05",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "704-403-4146",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "016GN",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "S.C. MEDICAID",
            "identifier": "QPB658",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI GROUP NO",
            "identifier": "396408",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135FE",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE STANDARD, NON NWK",
            "identifier": "561878722001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DF8926",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Development & Behavioral Pediatrics of the Carolina's",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; 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.