NPIMap

Organization Active NPI

The Presbyterian Hospital

Doing business as Diabetes Resource Center

  • Registered Dietitian
  • Charlotte, NC
National Provider Identifier
1649228255
Registry record updated Jul 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
THE PRESBYTERIAN HOSPITAL
Doing business as
Diabetes Resource Center
Practice address
1718 E 4TH St
Suite 207
Charlotte, NC 28204-3260
Phone
(704) 384-7390
Fax
(704) 384-5669
NPI assigned
May 5, 2006
Last updated
Jul 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2011

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

Authorized official

Name
Amy S Vance
Title
Sr. VP of Finance
Phone
(704) 384-6299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

1718 E 4TH St
Suite 207
Charlotte, NC 28204-3260

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other identifiers 1

IdentifierTypeStateIssuer
016JAOtherNCBCBS-NC

Other names 1

  • Diabetes Resource Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040223001121 NC Part B Supplier - Clinic/Group Practice 1153231907 Receives reassigned benefits from 988 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC; Cornelius, NC; Huntersville, NC; Matthews, NC; Monroe, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1649228255",
    "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": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E 4TH ST",
            "address_2": "SUITE 207",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043260",
            "telephone_number": "704-384-7390",
            "fax_number": "704-384-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRESBYTERIAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SR. VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-6299"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC",
            "identifier": "016JA",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Resource Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; 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.