NPIMap

Individual provider Active NPI

Mark Tae Myung Inda, DO

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1659877678
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2021-01061 Issued in NC
Practice address
8420 University Exec Park Dr Ste 850
Charlotte, NC 28262-1308
Phone
(704) 384-1225
Fax
(704) 384-1226
NPI assigned
Mar 30, 2018
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 2021-01061 NC Primary

Addresses

Primary practice location

8420 University Exec Park Dr Ste 850
Charlotte, NC 28262-1308

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address minda886115@direct.novanthealth.org

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
I20210817000901 NC Practitioner - Family Practice 1355699349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Virginia Campus, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

8420 University Exec Park Dr
Suite 850
Charlotte, NC 28262-1308
Phone (704) 384-1225

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2021-01061NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Feb 1, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jul 1, 2021 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

8420 University Exec Park Dr
Ste 850
Charlotte, NC 28262
Phone (704) 316-3850

8919 Park Rd
Charlotte, NC 28210
Phone (704) 384-1225

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

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

Interoperability endpoints

  • Direct secure messaging: minda886115@direct.novanthealth.org

Organizations & group practices 6

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

Hospital & facility affiliations 6

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": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1659877678",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8420 UNIVERSITY EXEC PARK DR STE 850",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621308",
            "telephone_number": "704-384-1225",
            "fax_number": "704-384-1226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave SE",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240141838",
            "country_code": "US",
            "telephone_number": "540-981-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INDA",
        "first_name": "MARK",
        "middle_name": "TAE MYUNG",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-30",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2021-01061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "minda886115@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "8420 University Exec Park Dr Ste 850",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282621308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.