NPIMap

Organization Active NPI

CMC-Northeast, Inc.

Doing business as NorthEast Pediatric Pulmonology

  • Pediatric Pulmonology Physician
  • Concord, NC
National Provider Identifier
1710156815
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
Legal business name
CMC-NORTHEAST, INC.
Doing business as
NorthEast Pediatric Pulmonology
Practice address
100 Medical Park Dr
Pediatric Pavilion - Suite 310
Concord, NC 28025-2948
Phone
(704) 403-2660
Fax
(704) 403-2670
NPI assigned
Feb 22, 2008
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CMC-NORTHEAST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Authorized official

Name
Frieda M Lowder
Title
Sr VP
Phone
(704) 403-4146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X NU Primary

Addresses

Primary practice location

100 Medical Park Dr
Pediatric Pavilion - Suite 310
Concord, NC 28025-2948

Mailing address

100 Medical Park Dr
Pediatric Pavilion - Suite 310
Concord, NC 28025-2948
Phone (704) 403-2660

Other identifiers 4

IdentifierTypeStateIssuer
020C9OtherNCBCBS NC
DF8926OtherNCRAILROAD MEDICARE PTAN
QPB689MedicaidSC
5909138MedicaidNC

Other names 1

  • NorthEast Pediatric Pulmonology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CMC - Northeast Inc44 organizations share this tax ID, including this one
Part of
CMC - Northeast Inc

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1710156815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PARK DR",
            "address_2": "PEDIATRIC PAVILION - SUITE 310",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252948",
            "telephone_number": "704-403-2660",
            "fax_number": "704-403-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PARK DR",
            "address_2": "PEDIATRIC PAVILION - SUITE 310",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252948",
            "telephone_number": "704-403-2660",
            "fax_number": "704-403-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMC-NORTHEAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CMC-NORTHEAST, INC.",
        "enumeration_date": "2008-02-22",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "020C9",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DF8926",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "QPB689",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909138",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthEast Pediatric Pulmonology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.