NPIMap

Organization Active NPI

CMC-Northeast, Inc.

Doing business as Carolina Pediatric Surgery

  • Pediatric Surgery Physician
  • Concord, NC
National Provider Identifier
1679512677
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
Legal business name
CMC-NORTHEAST, INC.
Doing business as
Carolina Pediatric Surgery
Practice address
100 Medical Park Dr
Suite 310 -Carolina Pediatric Surgery
Concord, NC 28025-2966
Phone
(704) 403-2660
Fax
(704) 403-2670
NPI assigned
Jun 5, 2006
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CMC-NORTHEAST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Authorized official

Name
Frieda M Lowder
Title
VP Physician Services
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X NU Primary

Addresses

Primary practice location

100 Medical Park Dr
Suite 310 -Carolina Pediatric Surgery
Concord, NC 28025-2966

Mailing address

100 Medical Park Dr
Suite 310 -Carolina Pediatric Surgery
Concord, NC 28025-2966
Phone (704) 403-2660

Other identifiers 9

IdentifierTypeStateIssuer
241255803OtherNCTRICARE
5901473MedicaidNC
5906961MedicaidNC
355573OtherNCMAMSI
019FNOtherNCBCBS EFF 7-1-07
7878267OtherNCAETNA
DF8926OtherNCRAILROAD MEDICARE PTAN
QPB706MedicaidSC
017CPOtherNCBCBS EFF PRIOR TO 7-1-07

Other names 1

  • CAROLINA PEDIATRIC SURGERY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC - Northeast Inc44 organizations share this tax ID, including this one
Part of
CMC - Northeast Inc

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1679512677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PARK DR",
            "address_2": "SUITE 310 -CAROLINA PEDIATRIC SURGERY",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252966",
            "telephone_number": "704-403-2660",
            "fax_number": "704-403-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PARK DR",
            "address_2": "SUITE 310 -CAROLINA PEDIATRIC SURGERY",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252966",
            "telephone_number": "704-403-2660",
            "fax_number": "704-403-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2006-06-05",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "241255803",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901473",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906961",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "355573",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EFF 7-1-07",
            "identifier": "019FN",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7878267",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DF8926",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "QPB706",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EFF PRIOR TO 7-1-07",
            "identifier": "017CP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAROLINA PEDIATRIC SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.