NPIMap

Organization Active NPI

Carolinas Medical Center

Doing business as Carolinas Psychiatry and Behavioral Wellness

  • Clinical Psychologist
  • Charlotte, NC
National Provider Identifier
1720334204
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CAROLINAS MEDICAL CENTER
Doing business as
Carolinas Psychiatry and Behavioral Wellness
Practice address
7825 Ballantyne Commons Pkwy
Suite a
Charlotte, NC 28277-3174
Phone
(704) 446-8031
Fax
(704) 446-8038
NPI assigned
Aug 2, 2012
Last updated
Aug 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

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

Authorized official

Name
Mr. Thomas Ford Laymon
Title
SVP
Phone
(704) 631-0002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

7825 Ballantyne Commons Pkwy
Suite a
Charlotte, NC 28277-3174

Mailing address

PO Box 601372
Charlotte, NC 28260-1372
Phone (704) 446-8031

Other identifiers 1

IdentifierTypeStateIssuer
6008865MedicaidNC

Other names 1

  • Carolinas Psychiatry and Behavioral Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000116 NC Part B Supplier - Clinic/Group Practice 4789597477 Receives reassigned benefits from 2,635 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Ctr for Mental Health69 organizations share this tax ID, including this one

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

Locations

7825 Ballantyne Commons Pkwy
Ste A
Charlotte, NC 28277
Phone (704) 446-8031

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1343865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470873600000",
    "number": "1720334204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601372",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601372",
            "telephone_number": "704-446-8031",
            "fax_number": "704-446-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7825 BALLANTYNE COMMONS PKWY",
            "address_2": "SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773174",
            "telephone_number": "704-446-8031",
            "fax_number": "704-446-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-02",
        "last_updated": "2016-08-11",
        "status": "A",
        "authorized_official_last_name": "LAYMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "FORD",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "704-631-0002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008865",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolinas Psychiatry and Behavioral Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.