Michael Leon Tjahjadi, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2023-02709 Issued in NC

Practice address

728 Hartness Rd
Statesville, NC 28677-3425

Phone

(704) 360-6420

NPI assigned

Jun 4, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mtjahjadi821464@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Iredell Physician Network LLC

  • General Practice Physician
  • Statesville, NC
  • NPI 1811381593
  Medicare reassignment NPD
• Iredell Physician Network

  dba Iredell Neurospine

  • Neurological Surgery Physician
  • Hickory, NC
  • NPI 1023402732
  NPD
• Iredell Physician Network LLC

  dba Iredell Ear, Nose and Throat

  • Otolaryngology Physician
  • Statesville, NC
  • NPI 1447063920
  NPD

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1699188912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1904",
            "fax_number": "704-865-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 HARTNESS RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773425",
            "telephone_number": "704-360-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TJAHJADI",
        "first_name": "MICHAEL",
        "middle_name": "LEON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-04",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2023-02709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayley Brooke Thompson
• Tiffany Cherie Thompson, CNM
• Engle Ashley Tillotson
• Maggie Rose Timmerman, LCSW-A
• Ashley Tipper
• TK Education and Consulting Solutions PLLC
• Tko Anesthesia PA
• Susan Helene Todd, LPN
• Jessica Tomlin, M.S. CCC-SLP
• Heriberto Enrique Torrealba, FNP

• Pediatrics Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.