Individual provider Active NPI

Andriy Omelyash

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1679207161
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5016568 Issued in NC
Practice address
1918 Randolph Rd Ste 580
Charlotte, NC 28207-1116
Phone
(704) 384-9900
Fax
(704) 384-9919
NPI assigned
Jul 12, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X 275930 NC
Nurse Practitioner 363L00000X 5016568 NC Primary

Addresses

Primary practice location

1918 Randolph Rd Ste 580
Charlotte, NC 28207-1116

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-9900

Other practice location 1

200 Hawthorne Ln
Charlotte, NC 28204-2515
Phone (704) 384-4121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220907001224 NC Practitioner - Nurse Practitioner 0749664985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

10030 Gilead Rd
Suite 300
Huntersville, NC 28078-7545
Phone (704) 384-7972

Hospital & facility affiliations

  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5016568NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2022 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

1918 Randolph Rd
Ste 580
Charlotte, NC 28207
Phone (704) 333-9113

10030 Gilead Rd
Ste 300
Huntersville, NC 28078
Phone (704) 384-7972

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: aomelyash674981@direct.novanthealth.org

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1679207161",
    "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": "704-384-9900",
            "fax_number": "704-384-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071116",
            "telephone_number": "704-384-9900",
            "fax_number": "704-384-9919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawthorne Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042515",
            "country_code": "US",
            "telephone_number": "704-384-4121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMELYASH",
        "first_name": "ANDRIY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "275930",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5016568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.