NPIMap

Organization Active NPI

Pediatric Endocrinology & Diabetes Specialists

  • Pediatric Endocrinology Physician
  • Charlotte, NC
National Provider Identifier
1679582134
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
Legal business name
PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTS
Doing business as
Pediatric Endocrinology & Diabetes Specialists
Practice address
4501 Cameron Valley Pkwy
Ste 200
Charlotte, NC 28211-4297
Phone
(704) 512-3636
NPI assigned
Aug 5, 2006
Last updated
Mar 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Scott Rissmiller
Title
Enterprise Evp
Phone
(704) 355-8675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X NU Primary

Addresses

Primary practice location

4501 Cameron Valley Pkwy
Ste 200
Charlotte, NC 28211-4297

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 1

  • Pediatric Endocrinology & Diabetes Specialists Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
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

National Provider Directory

National Provider Directory
Part of
Pediatric Endocrinology Diabetes Specialists

Locations

4501 Cameron Valley Pkwy
Ste 200
Charlotte, NC 28211
Phone (704) 512-5836

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1679582134",
    "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",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114297",
            "telephone_number": "704-512-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ENDOCRINOLOGY & DIABETES SPECIALISTS",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "4501 Cameron Valley Pkwy",
            "address_2": "Ste 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282114297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pediatric Endocrinology & Diabetes Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Endocrinology & Diabetes Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.