NPIMap

Individual provider Active NPI

Madison Hanna Walters

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1629676887
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11085 Issued in NC
Practice address
125 Queens Rd Ste 200
Charlotte, NC 28204-3215
Phone
(704) 343-9800
Fax
(704) 347-2011
NPI assigned
Oct 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-11085 NC Primary

Addresses

Primary practice location

125 Queens Rd Ste 200
Charlotte, NC 28204-3215

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 343-9800

Other practice location 1

222 Old Fayetteville Rd Apt I202
Carrboro, NC 27510-5510
Phone (919) 280-4220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220426001935 NC Practitioner - Physician Assistant 9830586643 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Presbyterian HospitalGroup PAC ID 1153231907, 412 clinicians

Practice addresses (Care Compare)

125 Queens Rd
Charlotte, NC 28204-3215

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-9073

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-11085NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince May 1, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 1, 2022 Accepting new patients
The Presbyterian Hospital CurrentSince May 1, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 1, 2022 Accepting new patients
The Presbyterian Hospital CurrentSince May 1, 2022 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

301 Hawthorne Ln
Ste 200
Charlotte, NC 28204
Phone (704) 316-5100

125 Queens Rd
Ste 200
Charlotte, NC 28204

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

125 Baldwin Ave
Ste 200
Charlotte, NC 28204
Phone (704) 384-5043

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: mhanna1041065@direct.novanthealth.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1602374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1629676887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-343-9800",
            "fax_number": "704-347-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 QUEENS RD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043215",
            "telephone_number": "704-343-9800",
            "fax_number": "704-347-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Old Fayetteville Rd Apt I202",
            "address_purpose": "LOCATION",
            "city": "Carrboro",
            "state": "NC",
            "postal_code": "275105510",
            "country_code": "US",
            "telephone_number": "919-280-4220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MADISON",
        "middle_name": "HANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-11",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.