NPIMap

Individual provider Active NPI

Michael E. Etomi, MD

  • Nephrology Physician
  • Charlotte, NC
National Provider Identifier
1720039787
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
35637 Issued in NC
Practice address
3033 Eastway Dr Ste 201
Charlotte, NC 28205-6387
Phone
(704) 731-6451
Fax
(704) 731-6452
NPI assigned
May 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 35637 NC Primary

Addresses

Primary practice location

3033 Eastway Dr Ste 201
Charlotte, NC 28205-6387

Mailing address

PO Box 37938
Charlotte, NC 28237-7938
Phone (704) 332-0366

Other identifiers 2

IdentifierTypeStateIssuer
8930891MedicaidNC
N35637MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address michaeletomi@mnapa.allscriptsdirect.net Direct

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
I20100618000378 NC Practitioner - NephrologyPractitioner - Internal Medicine 5890872154 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metrolina Nephrology Associates PAGroup PAC ID 8022916600, 85 clinicians

Practice addresses (Care Compare)

3158 Freedom Dr
Suite 3102
Charlotte, NC 28208-3870
Phone (704) 731-6857

Hospital & facility affiliations

  • DaVita Dialysis care of Anson County Dialysis facility, Wadesboro, NC, CCN 342560
  • Fresenius Medical Care Mallard Creek Dialysis facility, Charlotte, NC, CCN 342766
  • Usrc Latrobe Dialysis Dialysis facility, Charlotte, NC, CCN 342552
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Mint Hill Medical Center Hospital, Charlotte, NC, CCN 340190

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35637NCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Nephrology CurrentSince May 1, 2010 Accepting new patients
Metrolina Nephrology Associates, PA Nephrology CurrentSince Feb 1, 1997 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Medical Center CurrentSince May 1, 2010 Accepting new patients

Locations

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

3158 Freedom Dr
Ste 3101
Charlotte, NC 28208

3033 Eastway Dr
Ste 201
Charlotte, NC 28205
Phone (704) 316-4517

1300 Baxter St
Ste 215
Charlotte, NC 28204

3158 Freedom Dr
Ste 3102
Charlotte, NC 28208
Phone (704) 731-6857

2711 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 342-1900

2544 Court Dr
Ste F
Gastonia, NC 28054
Phone (704) 864-8302

Interoperability endpoints

  • Direct secure messaging: metomi499717@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: metomi66439@direct.acumenmd.com

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1720039787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37938",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282377938",
            "telephone_number": "704-332-0366",
            "fax_number": "704-971-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 EASTWAY DR STE 201",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056387",
            "telephone_number": "704-731-6451",
            "fax_number": "704-731-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETOMI",
        "first_name": "MICHAEL",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "35637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8930891",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N35637",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michaeletomi@mnapa.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Allscript Direct Messaging Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CED",
            "address_1": "2711 Randolph Rd",
            "address_2": "Bldg 400",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282072027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.