NPIMap

Organization Active NPI

ENT Carolina PA

  • Specialist
  • Gastonia, NC
National Provider Identifier
1699760702
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ENT CAROLINA PA
Practice address
2520 Aberdeen Blvd
Gastonia, NC 28054-0635
Phone
(704) 868-8400
Fax
(704) 868-8493
NPI assigned
Sep 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Mrs. Jane A Byrum
Title
Practice Administrator
Phone
(704) 868-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2520 Aberdeen Blvd
Gastonia, NC 28054-0635

Mailing address

2520 Aberdeen Blvd
Gastonia, NC 28054-0635
Phone (704) 868-8400

Other identifiers 4

IdentifierTypeStateIssuer
0171MOtherNCBLUE CROSS BLUE SHIELD
CA9743OtherNCRAILROAD MEDICARE
890171MMedicaidNC
0930362OtherNCAETNA HEALTHPLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060613000050 NC Part B Supplier - Clinic/Group Practice 1456363407 Receives reassigned benefits from 15 practitioners
Practice locations: Gastonia, NC; Shelby, NC; Belmont, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1699760702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 ABERDEEN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540635",
            "telephone_number": "704-868-8400",
            "fax_number": "704-868-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 ABERDEEN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540635",
            "telephone_number": "704-868-8400",
            "fax_number": "704-868-8493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT CAROLINA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "BYRUM",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-868-8400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0171M",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA9743",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890171M",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHPLAN",
            "identifier": "0930362",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.