The Charlotte-Mecklenburg Hospital Authority
Organization Active NPI Obstetrics & Gynecology Physician · Concord, NC
NPI 1669809158 · NPPES record last updated Mar 9, 2023
Key facts
- NPI
- 1669809158
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
- Practice address
- 920 Church St N
Ste 255E
Concord, NC 28025-2927 - Phone
- (704) 403-1632
- NPI assigned
- Sep 30, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Authorized official
- Name
- Scott Rissmiller
- Title
- Enterprise Evp
- Phone
- (704) 355-8675
Practitioners 17
-
Marcia H Ballard, FNP
-
Lisa Marie Gregg, PA
-
Radhika Tirumala, MD
-
Madeline Bundy, MPH, CNM, WHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100309000605 | NC | Part B Supplier - Clinic/Group Practice | 2961310685 |
Receives reassigned benefits from 1,831 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Charlotte Mecklenburg Hospital Authority
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
920 Church St N
Ste 255E
Concord, NC 28025-2927
Mailing address
PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002
Other names
- CHS OBGYN Hospitalists
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
| Direct Messaging Address | Ambulatory@direct.carolinashealthcare.org | Atrium Health |
Other providers in Concord, NC
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
- The Charlotte-Mecklenburg Hospital Authority
All providers in Concord, NC · Obstetrics & Gynecology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.