NPIMap

Organization Active NPI

Carolinas Physicians Network Inc

Doing business as The Sanger Clinic

  • Pediatric Cardiology Physician
  • Gastonia, NC
National Provider Identifier
1700101128
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Doing business as
The Sanger Clinic
Practice address
2550 Court Dr
Suite 203
Gastonia, NC 28054-2152
Phone
(704) 373-0212
Fax
(704) 342-5871
NPI assigned
Mar 29, 2010
Last updated
Jun 19, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS PHYSICIANS NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

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

Authorized official

Name
Daniel L Wiens
Title
Senior Vice President Operations
Phone
(704) 355-0648

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Pediatric Cardiology Physician 2080P0202X NU Primary
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

2550 Court Dr
Suite 203
Gastonia, NC 28054-2152

Mailing address

PO Box 601067
Charlotte, NC 28260-1067
Phone (704) 373-0212

Other identifiers 2

IdentifierTypeStateIssuer
5903908MedicaidNC
NPB175MedicaidSC

Other names 1

  • The Sanger Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000455 NC Part B Supplier - Clinic/Group Practice 3375449655 Receives reassigned benefits from 1,949 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Carolinas Physicians Network Inc

Locations

2550 Court Dr
Ste 203
Gastonia, NC 28054
Phone (704) 381-1450

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1700101128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601067",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601067",
            "telephone_number": "704-373-0212",
            "fax_number": "704-342-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 COURT DR",
            "address_2": "SUITE 203",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542152",
            "telephone_number": "704-373-0212",
            "fax_number": "704-342-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "enumeration_date": "2010-03-29",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT OPERATIONS",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903908",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB175",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Sanger Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 19, 2013; 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.