NPIMap

Organization Active NPI

Psychiatric Services of Carolinas, P.C.

  • Specialist
  • Gastonia, NC
National Provider Identifier
1710012174
Registry record updated Mar 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PSYCHIATRIC SERVICES OF CAROLINAS, P.C.
Practice address
1530 Union Rd Ste a
Gastonia, NC 28054-2201
Phone
(704) 867-6188
Fax
(704) 866-4437
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2019

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

Authorized official

Name
Dr. Nilima V Shukla, M.D.NPI 1922189877
Title
Owner
Phone
(704) 867-6188

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 1

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

Addresses

Primary practice location

1530 Union Rd Ste a
Gastonia, NC 28054-2201

Mailing address

1530 Union Rd Ste a
Gastonia, NC 28054-2201
Phone (704) 867-6188

Other practice location 1

615 S Dekalb St
Shelby, NC 28150-6184
Phone (704) 480-1882

Other identifiers 2

IdentifierTypeStateIssuer
1088LOtherNCBLUE CROSS BLUE SHIELD
5911302MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070312000082 NC Part B Supplier - Clinic/Group Practice 7315040458 Receives reassigned benefits from 11 practitioners
Practice locations: Gastonia, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2039108Psychiatric Services of Carolinas, PC1530 Union Road, Suite a, Gastonia, NC 28054AccreditationApr 15, 2028

National Provider Directory

National Provider Directory

Locations

2505 Court Dr
Gastonia, NC 28054
Phone (704) 842-6359

1610 E Marion St
Ste 250
Shelby, NC 28150
Phone (704) 480-1882

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553904000000",
    "number": "1710012174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 UNION RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542201",
            "telephone_number": "704-867-6188",
            "fax_number": "704-866-4437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 UNION RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542201",
            "telephone_number": "704-867-6188",
            "fax_number": "704-866-4437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 S Dekalb St",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "NC",
            "postal_code": "281506184",
            "country_code": "US",
            "telephone_number": "704-480-1882",
            "fax_number": "704-480-1832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHIATRIC SERVICES OF CAROLINAS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2019-03-30",
        "status": "A",
        "authorized_official_last_name": "SHUKLA",
        "authorized_official_first_name": "NILIMA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-867-6188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1088L",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911302",
            "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 Mar 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.