NPIMap

Individual provider Active NPI

Kelley Carlson, MD

  • Emergency Medicine Physician
  • Charlotte, NC
National Provider Identifier
1710113063
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2012-01202 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-2171
NPI assigned
Jun 1, 2009
Last updated
Oct 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2012-01202 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health

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
I20120803000264 NC Practitioner - Emergency Medicine 7911153135 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Michigan Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216-8644
Phone (336) 716-2255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012-01202NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Emergency Medicine CurrentSince Jul 1, 2012 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Medical Center CurrentSince Jul 1, 2012 Accepting new patients
Wake Forest Emergency Providers CurrentSince Jan 11, 2022 Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

6965 Fairview Rd
Charlotte, NC 28210
Phone (704) 631-1300

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

3536 Mt Holly Huntersville Rd
Charlotte, NC 28216
Phone (704) 801-6500

706 W King St
Kings Mtn, NC 28086
Phone (704) 730-5108

201 E Grover St
Shelby, NC 28150
Phone (704) 487-3000

Interoperability endpoints

  • Direct secure messaging: kcarlson500476@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: ambulatory@direct.carolinashealthcare.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1710113063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "KELLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2012-01202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1000 Blythe Blvd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.