NPIMap

Organization Active NPI

Hometown Oxygen Charlotte, LLC

  • Oxygen Equipment & Supplies (DME)
  • Leland, NC
National Provider Identifier
1619909496
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
License
01117 Issued in NC
Legal business name
HOMETOWN OXYGEN CHARLOTTE, LLC
Practice address
2205 Mercantile Dr NE
Suite 2
Leland, NC 28451
Phone
(888) 902-3502
NPI assigned
Jul 6, 2006
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Mr. Paul Jardina
Title
Ceo
Phone
(866) 776-6782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X 01117 NC Primary

Addresses

Primary practice location

2205 Mercantile Dr NE
Suite 2
Leland, NC 28451

Mailing address

41 Spring St.
Suite 103
New Providence, NJ 07974
Phone (704) 347-2233

Other practice location 1

1303 7th Ave E Ste C&d
Hendersonville, NC 28792-2893
Phone (704) 347-2233 ext. 200

Other identifiers 1

IdentifierTypeStateIssuer
DE2779MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930020145 NC DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 0446452411 Practice locations: Leland, NC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Hometown Oxygen Charlotte LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1428 Perfection Ave
Unit 4
Belmont, NC 28012

1303 7th Ave E
Hendersonville, NC 28792
Phone (812) 581-0121

1303 7th Ave E
Ste Cd
Hendersonville, NC 28792
Phone 7043472233 ext. 200

2205 Mercantile Dr
Unit 2
Leland, NC 28451
Phone (888) 902-3502

2154 N Center St
Ste 306C
North Charleston, SC 29406
Phone (704) 347-2233

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1619909496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 SPRING ST.",
            "address_2": "SUITE 103",
            "city": "NEW PROVIDENCE",
            "state": "NJ",
            "postal_code": "07974",
            "telephone_number": "704-347-2233",
            "fax_number": "704-331-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 MERCANTILE DR NE",
            "address_2": "SUITE 2",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "28451",
            "telephone_number": "888-902-3502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1303 7th Ave E Ste C&d",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "NC",
            "postal_code": "287922893",
            "country_code": "US",
            "telephone_number": "704-347-2233 x200",
            "fax_number": "704-331-4702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOMETOWN OXYGEN CHARLOTTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-08-01",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "JARDINA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-776-6782",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NC",
            "license": "01117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE2779",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leland, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.