Individual provider Active NPI

Hans Mawuli Kwaku, M.D.

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1689630691
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
200300167 Issued in NC
Practice address
5815 Blakeney Park Dr Ste 200B
Charlotte, NC 28277-5734
Phone
(704) 316-5080
Fax
(704) 316-5085
NPI assigned
Apr 26, 2006
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200300167 NC
Adolescent Medicine (Family Medicine) Physician 207QA0000X 200300167 NC
Adult Medicine Physician 207QA0505X 200300167 NC
Internal Medicine Physician 207R00000X 200300167 NC Primary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X 200300167 NC

Addresses

Primary practice location

5815 Blakeney Park Dr Ste 200B
Charlotte, NC 28277-5734

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

3627 Beatties Ford Rd
Charlotte, NC 28216-3249
Phone (704) 335-0806

Other identifiers 1

IdentifierTypeStateIssuer
89135CYMedicaidNC

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
I20040914001419 NC Practitioner - Internal Medicine 1052388428 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300167NCMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bomray Medical Clinic CurrentSince Aug 1, 2004 Accepting new patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Aug 3, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 3, 2024 Accepting new patients
Sports and Spine Physical Therapy NC Inc Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

3627 Beatties Ford Rd
Charlotte, NC 28216
Phone (704) 335-0806

5815 Blakeney Park Dr
Ste 200B
Charlotte, NC 28277
Phone (704) 316-5080

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: hkwaku1587829@direct.novanthealth.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.

Hospital & facility affiliations 4

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1689630691",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 BLAKENEY PARK DR STE 200B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775734",
            "telephone_number": "704-316-5080",
            "fax_number": "704-316-5085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3627 Beatties Ford Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282163249",
            "country_code": "US",
            "telephone_number": "704-335-0806",
            "fax_number": "704-334-2073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAKU",
        "first_name": "HANS",
        "middle_name": "MAWULI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200300167",
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "NC",
            "license": "200300167",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NC",
            "license": "200300167",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200300167",
            "primary": true
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "NC",
            "license": "200300167",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135CY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.