NPIMap

Organization Active NPI

Carolina Anesthesia Associates PA

  • Anesthesiology Physician
  • Statesville, NC
National Provider Identifier
1699723791
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CAROLINA ANESTHESIA ASSOCIATES PA
Practice address
646 Hartness Road
Statesville, NC 28677
Phone
(704) 871-0081
NPI assigned
May 4, 2006
Last updated
Sep 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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

Authorized official

Name
Mr. Jeffrey N Caudle, CRNANPI 1568402899
Title
President
Phone
(828) 327-6673

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

646 Hartness Road
Statesville, NC 28677

Mailing address

292A 9TH Ave Dr NE
Hickory, NC 28601
Phone (828) 327-6673

Other identifiers 2

IdentifierTypeStateIssuer
8000263MedicaidNC
GP3620MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC, VA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040112000005 SC Part B Supplier - Clinic/Group Practice 1456251057 Receives reassigned benefits from 133 practitioners
Practice locations: Bennettsville, SC; West Columbia, SC; Walterboro, SC; Spartanburg, SC; Myrtle Beach, SC; Lancaster, SC; Georgetown, SC; Columbia, SC…
O20040115000938 NC Part B Supplier - Clinic/Group Practice 1456251057 Receives reassigned benefits from 192 practitioners
Practice locations: Morganton, NC; Pinehurst, NC; Salisbury, NC; Wilmington, NC; Sanford, NC; Statesville, NC; Mooresville, NC; Wilson, NC…
O20060505000624 NC Part B Supplier - Clinic/Group Practice 1456251057 Receives reassigned benefits from 8 practitioners
Practice locations: Mooresville, NC; Wilson, NC; Wilmington, NC; Wadesboro, NC; Charlotte, NC; Lenoir, NC; Lumberton, NC
O20130820000132 VA Part B Supplier - Clinic/Group Practice 1456251057 Receives reassigned benefits from 4 practitioners
Practice locations: Danville, VA

National Provider Directory

National Provider Directory

Locations

134 Mountainside Village Pkwy
#P
Jasper, GA 30143
Phone (706) 253-7340

2015 Randolph Rd
Ste 208
Charlotte, NC 28207
Phone (704) 602-6544

50 13th Ave NE
Hickory, NC 28601
Phone (828) 345-5885

401 Mulberry St SW
Ste 206
Lenoir, NC 28645
Phone (828) 572-1770

614 Hospital Ave NW
Lenoir, NC 28645
Phone (828) 754-1600

106 Alexander Bank Dr
Ste 100
Mooresville, NC 28117
Phone (704) 660-4055

150 Fairview Rd
Ste 120
Mooresville, NC 28117
Phone (704) 659-4499

309 Alcove Rd
Mooresville, NC 28117
Phone (704) 660-4055

107 Mica Ave
#B
Morganton, NC 28655
Phone (828) 437-7702

508 Morven Rd
Wadesboro, NC 28170
Phone (704) 694-6902

1717 Shipyard Blvd
Ste 210
Wilmington, NC 28403
Phone (910) 392-7877

3520 Airport Blvd NW
Ste E
Wilson, NC 27896
Phone (252) 206-5622

2073 Charlie Hall Blvd
Charleston, SC 29414
Phone (843) 571-0643

945 82nd Pkwy
Ste 2
Myrtle Beach, SC 29572
Phone (843) 839-0823

1530 Boiling Springs Rd
Spartanburg, SC 29316
Phone (864) 583-6381

Practitioners & affiliated clinicians

Practitioners 265

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.

View all 265

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1699723791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292A 9TH AVE DR NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "28601",
            "telephone_number": "828-327-6673",
            "fax_number": "828-327-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 HARTNESS ROAD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-871-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA ANESTHESIA ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "CAUDLE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-327-6673",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000263",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3620",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.