Nicole Vital, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

9600 E Independence Blvd Ste B
Matthews, NC 28105-4628

Phone

(704) 815-5624

Fax

(704) 815-5621

NPI assigned

Sep 12, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations (25 of 27)

Interoperability endpoints

• Direct secure messaging: nvital407882@direct.novanthealth.org

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.

• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment Care Compare group
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD
• Carolina Medicorp Enterprises Inc

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1417497504
  NPD (past)

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1720536378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601843",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 E INDEPENDENCE BLVD STE B",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281054628",
            "telephone_number": "704-815-5624",
            "fax_number": "704-815-5621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043041",
            "country_code": "US",
            "telephone_number": "980-308-0141",
            "fax_number": "980-308-3041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VITAL",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nvital407882@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "9600 E Independence Blvd Ste B",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281054628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• VG Group Inc
• Paola Andrea Vinas Joy, DC
• Thomas Joseph Vinci, BS PHARMACY
• Glenda Lena Vinson-Nnaji, LCMHCS, LCAS
• Visionworks, Inc.
• Peter John Vitello, MSPT
• Jennifer Lynn Voss, PA-C
• Lauren Michele Waggoner, PT, DPT
• Maciej Piotr Walczyszyn, M.D.
• Walgreen Co

• Physician Assistant in Matthews, NC
• Providers in Matthews, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.