NPIMap

Individual provider Active NPI

Eddie Dean Davis, PAC

  • Physician Assistant
  • Concord, NC
National Provider Identifier
1700876141
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103716 Issued in NC
Practice address
354 Copperfield Blvd NE
Concord, NC 28025-2402
Phone
(704) 323-2000
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103716 NC Primary

Addresses

Primary practice location

354 Copperfield Blvd NE
Concord, NC 28025-2402

Mailing address

4601 Park Rd
Suite 300
Charlotte, NC 28209-3239
Phone (704) 323-2000

Other identifiers 2

IdentifierTypeStateIssuer
C5985OtherNCMEDCOST
P00136713OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100824000562 NC Practitioner - Physician Assistant 8123142478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
May accept Medicare assignment
Group practices
Orthocarolina 288 clinicians
Carolina Physical Therapy Associates LLC 496 clinicians
Comprehab, Inc 376 clinicians

Practice addresses (Care Compare)

1915 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 323-2282

236 Lephillip Court
Suite a
Concord, NC 28025-1917
Phone (419) 221-6717

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

354 Copperfield Blvd NE
Concord, NC 28025-2402
Phone (704) 323-2276

Hospital & facility affiliations

  • Stanly Regional Medical Center Hospital, Albemarle, NC, CCN 340119

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocarolina Physician Assistant CurrentSince Apr 18, 2011 Accepting new patients
Orthocarolina Physician Assistant CurrentSince Apr 18, 2011 Accepting new patients

Locations

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

354 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 262-4181

Organizations & group practices 11

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1700876141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "SUITE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-323-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 COPPERFIELD BLVD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252402",
            "telephone_number": "704-323-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EDDIE",
        "middle_name": "DEAN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "C5985",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00136713",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.