Active NPI
Cavin Fertil, MS CCC SLP
- Speech-Language Pathologist
- Charlotte, NC
National Provider Identifier
1679635627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6728
- Practice address
- 12706 Woodrose CT
Charlotte, NC 28262-1543 - Phone
- (704) 549-0623
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6728 | NC | Primary |
Addresses
Primary practice location
12706 Woodrose CT
Charlotte, NC 28262-1543
Mailing address
12706 Woodrose CT
Charlotte, NC 28262-1543
Phone (704) 549-0623
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7412067 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6728 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1679635627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12706 WOODROSE CT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282621543",
"telephone_number": "704-549-0623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12706 WOODROSE CT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282621543",
"telephone_number": "704-549-0623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERTIL",
"first_name": "CAVIN",
"name_prefix": "Mr.",
"credential": "MS CCC SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "6728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7412067",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.