NPIMap

Organization Active NPI

Carolinas Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Charlotte, NC
National Provider Identifier
1720029705
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
CAROLINAS MEDICAL CENTER
Practice address
1000 Blythe Blvd, 10TH Floor
Charlotte, NC 28203-5812
Phone
(704) 355-2000
Fax
(704) 355-5073
NPI assigned
Jun 9, 2006
Last updated
Nov 20, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Authorized official

Name
Mr. Kenneth D Haynes
Title
President
Phone
(704) 355-6305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1000 Blythe Blvd, 10TH Floor
Charlotte, NC 28203-5812

Mailing address

PO Box 32861
Charlotte, NC 28232-2861
Phone (704) 512-6438

Other names 1

  • Carolinas Medical Center - ESRD Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051026000200 NC Part A Provider - Hospital 4789597477 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20120525000578 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 4789597477 Practice locations: Charoltte, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720029705. Details of each certification follow.

Hospital certification: CCN 340113

Legal name
CAROLINAS MEDICAL CENTER
Doing business as
CAROLINAS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 4, 2011
Beds
843
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Jun 26, 1943 in NC
Enrollment address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Rehabilitation, Psychiatric unit, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Carolinas Medical Center/Behav HealthCCN 340113 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
CMC Randloph69 organizations share this tax ID, including this one
Part of
CMC Randloph

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1000 Blythe Blvd
Fl 10
Charlotte, NC 28203
Phone (704) 355-2098

Ownership & related parties

All disclosed owners & managing parties 36

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gary B Gragg Individual Corporate DirectorBoard Member Jan 1, 2020
Callie F Dobbins Individual W-2 Managing EmployeeVP - Facility Executive Jan 1, 2020
Luther Amos Lockwood Individual Corporate DirectorBoard Member Jan 1, 2025
David a Danzie Individual Corporate DirectorBoard Member Jan 1, 2020
William C Cannon Individual Corporate DirectorVice Chairman - Boc Jul 1, 2007
Theresa Marie Payton Individual Corporate DirectorBoard Member Jan 1, 2025
Angelique R Vincent-Hamacher Individual Corporate DirectorChairman - Boc Jan 1, 2014
Mark E Reed Individual Corporate DirectorVice Chairman & Secretary Boc Jan 1, 2020
Brett J Denton Individual Corporate OfficerAssistant Secretary Jan 1, 2025
Charles F Bowman Individual Corporate DirectorBoard Member Jan 1, 2020
Rodney E Ball Individual W-2 Managing EmployeeAdministrator Jan 3, 2019
Kenneth F Davis Individual Corporate DirectorBoard Member Jan 1, 2025
Adrienne S H Purdue Individual Corporate DirectorBoard Member Jan 1, 2020
The Charlotte-Mecklenburg Hospital Authority Organization, Charlotte, NC 5% Or Greater Direct Ownership Interest Nov 7, 2007
Operational/Managerial Control Nov 7, 2007
Luther Kissam Individual Corporate DirectorBoard Member Jan 1, 2025
Saju D Joy Individual W-2 Managing EmployeeVP & Chief Medical Officer Cent Mar Jan 1, 2020
Swati V Daji Individual Corporate DirectorBoard Member Jan 1, 2020
Kenneth D Haynes Individual Corporate DirectorPresident Jan 1, 2023
Felicia H Allen Individual Corporate DirectorBoard Member Jan 1, 2020
The Charlotte-Mecklenburg Hospital Authority Organization, Charlotte, NC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 7, 2007
Operational/Managerial Control Nov 7, 2007
Amanda S Houser Individual Corporate DirectorBoard Member Jan 1, 2022
Marshall Carlson Individual Corporate DirectorBoard Member Feb 11, 2016
Bradley Allen Clark Individual Corporate OfficerChief Financial Officer Aug 14, 2023
Nancy J Gritter Individual Corporate DirectorBoard Member Feb 3, 2017
Hal a Levinson Individual Corporate DirectorBoard Member Feb 11, 2016
Atrium Health Inc Organization, Charlotte, NC Corporation, Non-profit Operational/Managerial Control Oct 9, 2020
Advocate Health Inc Organization, Charlotte, NC Corporation, Non-profit Operational/Managerial Control Dec 2, 2022
Vicki J Block Individual W-2 Managing EmployeeSVP - Market President Central MKT Apr 1, 2019
Michael D Rucker Individual Corporate DirectorBoard Member Jan 1, 2013
Todd Jamal Collins Individual Corporate DirectorBoard Member Jan 1, 2025
Richard T Williams Individual Corporate DirectorBoard Member Jan 28, 2015
William T Niblock Individual Corporate DirectorBoard Member Jan 1, 2013
Steven Smoot Individual Corporate OfficerPresident Jun 2, 2025
Carl J. Herring Individual Corporate DirectorBoard Member Jan 1, 2022
Lucia Zapata Griffith Individual Corporate DirectorBoard Member Jan 1, 2025
Douglas Roush Individual W-2 Managing EmployeeVP - Facility Executive Jan 31, 2011

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 4,054

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 4,054

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1720029705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861",
            "telephone_number": "704-512-6438",
            "fax_number": "704-512-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD, 10TH FLOOR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2000",
            "fax_number": "704-355-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2006-06-09",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-355-6305",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Carolinas Medical Center - ESRD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.