Individual provider Active NPI

Dael Waxman, MD

  • General Practice Physician
  • Charlotte, NC
National Provider Identifier
1679581904
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
9601515 Issued in NC
Practice address
2001 Vail Ave
Ste 400
Charlotte, NC 28207-1248
Phone
(704) 304-7000
NPI assigned
Aug 3, 2006
Last updated
Sep 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 9601515 NC Primary

Addresses

Primary practice location

2001 Vail Ave
Ste 400
Charlotte, NC 28207-1248

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1106 Reynolds St
Ste 100
Monroe, NC 28112-4375
Phone (704) 289-5443

Other practice location 2

1801 Rozzelles Ferry Rd
Charlotte, NC 28208-4228
Phone (704) 446-9987

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051116000144 NC Practitioner - Family Practice 2466471743 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Family Medicine Current Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Medical Center CurrentSince Jan 1, 2007 Accepting new patients
Carolinas Medical Center CurrentSince Jan 1, 2007 Accepting new patients
Union Family Practice Family Medicine Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1801 Rozzelles Ferry Rd
Charlotte, NC 28208
Phone (704) 446-9987

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

2001 Vail Ave
Ste 400
Charlotte, NC 28207
Phone (704) 304-7000

Interoperability endpoints

  • Direct secure messaging: ambulatory@direct.carolinashealthcare.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1679581904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VAIL AVE",
            "address_2": "STE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071248",
            "telephone_number": "704-304-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 Reynolds St",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281124375",
            "country_code": "US",
            "telephone_number": "704-289-5443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1801 Rozzelles Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282084228",
            "country_code": "US",
            "telephone_number": "704-446-9987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAXMAN",
        "first_name": "DAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NC",
            "license": "9601515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "2001 Vail Ave",
            "address_2": "Ste 400",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.