NPIMap

Organization Active NPI

Carolinas Physicians Network Inc

Doing business as Carolina Breast Center

  • Surgery Physician
  • Rock Hill, SC
National Provider Identifier
1659709046
Registry record updated Feb 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Doing business as
Carolina Breast Center
Practice address
154 Amendment Ave
Rock Hill, SC 29732-3155
Phone
(803) 329-8990
NPI assigned
Oct 22, 2013
Last updated
Feb 25, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS PHYSICIANS NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2014

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

Authorized official

Name
Daniel Leslie Wiens
Title
SVP/Operations CPN
Phone
(704) 355-0648

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary
Plastic and Reconstructive Surgery Physician 2086S0122X NU

Addresses

Primary practice location

154 Amendment Ave
Rock Hill, SC 29732-3155

Mailing address

PO Box 602478
Charlotte, NC 28260-2478
Phone (803) 329-8990

Other identifiers 1

IdentifierTypeStateIssuer
GP6360MedicaidSC

Other names 1

  • Carolina Breast Center Doing business as

Medicare participation

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

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Part of
Carolinas Physicians Network Inc

Member of 3

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

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 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1659709046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602478",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602478",
            "telephone_number": "803-329-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 AMENDMENT AVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323155",
            "telephone_number": "803-329-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "enumeration_date": "2013-10-22",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "LESLIE",
        "authorized_official_title_or_position": "SVP/OPERATIONS CPN",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6360",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Breast Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; 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.