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Carolinas Medical Center

Organization Active NPI Psychiatry Physician · Davidson, NC

NPI 1629412184 · NPPES record last updated Mar 9, 2023

Key facts

NPI
1629412184
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
CAROLINAS MEDICAL CENTER
Practice address
16740 Davidson Concord Rd
Ste 200
Davidson, NC 28036-8746
Phone
(704) 801-9200
NPI assigned
Apr 26, 2013
Organization subpart
Yes
Parent organization (as reported)
CAROLINAS MEDICAL CENTER

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

Corporate family (same tax ID) 24

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

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 57

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2059084Atrium Health Behavioral Health Psychiatry
16740 Davidson-Concord Road, Davidson, NC 28036		Certificate of waiverMay 16, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031110000116 NC Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 2,635 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Ctr for Mental Health (69 organizations share this tax ID)
Part of
Ctr for Mental Health

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

16740 Davidson Concord Rd
Ste 200
Davidson, NC 28036-8746

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names

  • Atrium Health Behavioral Health Psychiatry & Counseling Davidson Doing business as
  • Carolinas Psychiatry and Behavioral Wellness Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

Other providers in Davidson, NC

All providers in Davidson, NC · Psychiatry Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.