Carolinas Medical Center

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Charlotte, NC

NPI 1720029705 · NPPES record last updated Nov 20, 2025

Key facts

NPI
1720029705
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 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
Organization subpart
Yes
Parent organization (as reported)
CAROLINAS MEDICAL CENTER

Authorized official

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

Owners & managing parties with NPI records 13

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

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 24

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

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

Practitioners 1,057

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

View all 1,057

Affiliated clinicians 4,054

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

View all 4,054

Medicare Care Compare: Hospital

Listed as
Carolinas Medical Center/Behav Health CCN 340113
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

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
Other · Non-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

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 Director
Board Member
Jan 1, 2020
Callie F Dobbins
Individual
W-2 Managing Employee
VP - Facility Executive
Jan 1, 2020
Luther Amos Lockwood
Individual
Corporate Director
Board Member
Jan 1, 2025
David a Danzie
Individual
Corporate Director
Board Member
Jan 1, 2020
William C Cannon
Individual
Corporate Director
Vice Chairman - Boc
Jul 1, 2007
Theresa Marie Payton
Individual
Corporate Director
Board Member
Jan 1, 2025
Angelique R Vincent-Hamacher
Individual
Corporate Director
Chairman - Boc
Jan 1, 2014
Mark E Reed
Individual
Corporate Director
Vice Chairman & Secretary Boc
Jan 1, 2020
Brett J Denton
Individual
Corporate Officer
Assistant Secretary
Jan 1, 2025
Charles F Bowman
Individual
Corporate Director
Board Member
Jan 1, 2020
Rodney E Ball
Individual
W-2 Managing Employee
Administrator
Jan 3, 2019
Kenneth F Davis
Individual
Corporate Director
Board Member
Jan 1, 2025
Adrienne S H Purdue
Individual
Corporate Director
Board 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 Director
Board Member
Jan 1, 2025
Saju D Joy
Individual
W-2 Managing Employee
VP & Chief Medical Officer Cent Mar
Jan 1, 2020
Swati V Daji
Individual
Corporate Director
Board Member
Jan 1, 2020
Kenneth D Haynes
Individual
Corporate Director
President
Jan 1, 2023
Felicia H Allen
Individual
Corporate Director
Board 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 Director
Board Member
Jan 1, 2022
Marshall Carlson
Individual
Corporate Director
Board Member
Feb 11, 2016
Bradley Allen Clark
Individual
Corporate Officer
Chief Financial Officer
Aug 14, 2023
Nancy J Gritter
Individual
Corporate Director
Board Member
Feb 3, 2017
Hal a Levinson
Individual
Corporate Director
Board 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 Employee
SVP - Market President Central MKT
Apr 1, 2019
Michael D Rucker
Individual
Corporate Director
Board Member
Jan 1, 2013
Todd Jamal Collins
Individual
Corporate Director
Board Member
Jan 1, 2025
Richard T Williams
Individual
Corporate Director
Board Member
Jan 28, 2015
William T Niblock
Individual
Corporate Director
Board Member
Jan 1, 2013
Steven Smoot
Individual
Corporate Officer
President
Jun 2, 2025
Carl J. Herring
Individual
Corporate Director
Board Member
Jan 1, 2022
Lucia Zapata Griffith
Individual
Corporate Director
Board Member
Jan 1, 2025
Douglas Roush
Individual
W-2 Managing Employee
VP - Facility Executive
Jan 31, 2011

Medicare enrollment records

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

National Provider Directory

Tax ID family
Ctr for Mental Health (69 organizations share this tax ID)
Part of
Ctr for Mental Health

Specialties & licenses

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

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

  • Carolinas Medical Center - ESRD Other name

Electronic endpoints

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

Other providers in Charlotte, NC

All providers in Charlotte, NC · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Carolina

Sources for this page

Verify at the official NPI Registry.