NPIMap

Organization Active NPI

Carolinas Medical Center

Doing business as Carolinas Back and Sports Specialists

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Monroe, NC
National Provider Identifier
1609174515
Registry record updated Mar 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
CAROLINAS MEDICAL CENTER
Doing business as
Carolinas Back and Sports Specialists
Practice address
1106 Reynolds St
Suite 200
Monroe, NC 28112-4375
Phone
(704) 512-4400
Fax
(704) 512-4401
NPI assigned
Mar 2, 2011
Last updated
Mar 2, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2011

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

Authorized official

Name
Dennie Underwood
Title
Vice President
Phone
(704) 355-3147

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Spinal Cord Injury Medicine Physician 2081P0004X
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X Primary

Addresses

Primary practice location

1106 Reynolds St
Suite 200
Monroe, NC 28112-4375

Mailing address

PO Box 601372
Charlotte, NC 28260-1372
Phone (704) 512-4400

Other names 1

  • Carolinas Back and Sports Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC Randloph69 organizations share this tax ID, including this one
Part of
CMC Randloph

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299024000000",
    "number": "1609174515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601372",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601372",
            "telephone_number": "704-512-4400",
            "fax_number": "704-512-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 REYNOLDS ST",
            "address_2": "SUITE 200",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124375",
            "telephone_number": "704-512-4400",
            "fax_number": "704-512-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-03-02",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DENNIE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-3147"
    },
    "taxonomies": [
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolinas Back and Sports Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; 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.