Individual provider Active NPI

Mary Elizabeth Tota-Faucette

  • Rehabilitation Psychologist
  • Charlotte, NC
National Provider Identifier
1699870295
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PsychologistTaxonomy code 103TR0400X
License
1886 Issued in NC
Practice address
125 Baldwin Ave
Suite 100
Charlotte, NC 28204-3227
Phone
(704) 316-1917
Fax
(704) 316-1924
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1886 NC
Rehabilitation Psychologist 103TR0400X 1886 NC Primary

Addresses

Primary practice location

125 Baldwin Ave
Suite 100
Charlotte, NC 28204-3227

Mailing address

2085 Frontis Plaza Blvd
Winston-Salem, NC 27103
Phone (336) 277-1065

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtotafaucette46683@direct.novanthealth.org

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100415000929 NC Practitioner - Clinical Psychologist 7911034327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
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)

13815 Professional Ctr Dr
Suite 100
Huntersville, NC 28078-7951
Phone (704) 384-1320

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1886NCMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince May 29, 2016 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 29, 2016 Accepting new patients
The Presbyterian Hospital CurrentSince Jan 1, 2010 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
The Presbyterian Hospital Current Accepting new patients
The Presbyterian Hospital CurrentSince Jan 1, 2010 Accepting new patients

Locations

1900 Randolph Rd
Ste 800
Charlotte, NC 28207
Phone (704) 941-4171

125 Baldwin Ave
Ste 100
Charlotte, NC 28204
Phone (704) 316-1900

1901 Randolph Rd
Charlotte, NC 28207
Phone (704) 316-2000

13815 Professional Center Dr
Ste 100
Huntersville, NC 28078
Phone (704) 316-2050

1401 Matthews Township Pkwy
Ste 320
Matthews, NC 28105
Phone (704) 316-9064

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2085 Frontis Plaza Blvd
Winston Salem, NC 27103
Phone (336) 277-7226

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1699870295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-277-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BALDWIN AVE",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043227",
            "telephone_number": "704-316-1917",
            "fax_number": "704-316-1924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOTA-FAUCETTE",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1886",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NC",
            "license": "1886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtotafaucette46683@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "125 Baldwin Ave",
            "address_2": "Suite 100",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.