NPIMap

Organization Active NPI

Carolinas Physicians Network Inc

Doing business as Atrium Health Primary Care Fort Mill Internal Medicine

  • Family Medicine Physician
  • Fort Mill, SC
National Provider Identifier
1649525619
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Doing business as
Atrium Health Primary Care Fort Mill Internal Medicine
Atrium Health Primary Care Pageland Family Medicine
Atrium Health Primary Care Shiland Family Medicine2 more in Other names
Practice address
704 Gold Hill Rd
Fort Mill, SC 29715-8906
Phone
(803) 835-0420
NPI assigned
Jul 17, 2012
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS PHYSICIANS NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X

Addresses

Primary practice location

704 Gold Hill Rd
Fort Mill, SC 29715-8906

Mailing address

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

Other practice location 1

1935 Holbrook Rd
Ste 1200
Fort Mill, SC 29715
Phone (803) 802-5181

Other practice location 2

1935 Holbrook Rd
Ste 1100
Fort Mill, SC 29715
Phone (803) 650-4282

Other practice location 3

301 N Van Lingle Mungo Blvd
Pageland, SC 29728-2319
Phone (843) 672-6127

Other names 5

  • Atrium Health Primary Care Fort Mill Internal Medicine Doing business as
  • Atrium Health Primary Care Pageland Family Medicine Doing business as
  • Atrium Health Primary Care Shiland Family Medicine Doing business as
  • Atrium Health Women's Care Piedmont OB GYN Doing business as
  • Pageland Family Medicine Doing business as

Electronic endpoints 2

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031209000106 SC Part B Supplier - Clinic/Group Practice 3375449655 Receives reassigned benefits from 359 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rock Hill, SC; Fort Mill, SC; Lancaster, SC; Indian Land, SC; Greenville, SC
O20230807000384 SC DME Supplier - Multi-Specialty - Physician 3375449655 Practice locations: Fort Mill, SC

Other NPIs on the same Medicare enrollment 16

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

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1049645Carolinas Physicians Network Inc Dba Atrium Health1935 Holbrook Road, Suite 1200, Fort Mill, SC 29715Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory
Part of
Carolinas Physician Network Inc

Member of 19

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

View all 19

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1649525619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 GOLD HILL RD",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297158906",
            "telephone_number": "803-835-0420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1935 Holbrook Rd",
            "address_2": "Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "29715",
            "country_code": "US",
            "telephone_number": "803-802-5181",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1935 Holbrook Rd",
            "address_2": "Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "29715",
            "country_code": "US",
            "telephone_number": "803-650-4282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 N Van Lingle Mungo Blvd",
            "address_purpose": "LOCATION",
            "city": "Pageland",
            "state": "SC",
            "postal_code": "297282319",
            "country_code": "US",
            "telephone_number": "843-672-6127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "enumeration_date": "2012-07-17",
        "last_updated": "2023-09-25",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "301 N Van Lingle Mungo Blvd",
            "city": "Pageland",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297282319",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Primary Care Fort Mill Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Primary Care Pageland Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Primary Care Pageland Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Primary Care Shiland Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Women's Care Piedmont OB GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pageland Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.