NPIMap

Organization Active NPI

Carolinas Physicians Network Inc

Doing business as Indian Trail Pediatrics

  • Pediatrics Physician
  • Indian Trail, NC
National Provider Identifier
1730198185
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Doing business as
Indian Trail Pediatrics
Practice address
6030 W Highway 74
Suite F
Indian Trail, NC 28079-3468
Phone
(704) 246-2900
Fax
(704) 246-2899
NPI assigned
Aug 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Daniel L Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

6030 W Highway 74
Suite F
Indian Trail, NC 28079-3468

Mailing address

PO Box 60026
Charlotte, NC 28260-0026
Phone (704) 246-2900

Other identifiers 3

IdentifierTypeStateIssuer
5901967MedicaidNC
017GYOtherNCBLUE CROSS - BLUE SHIELD
NPB120MedicaidSC

Other names 1

  • Indian Trail Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carolinas Physicians Network Inc135 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

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730198185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60026",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600026",
            "telephone_number": "704-246-2900",
            "fax_number": "704-246-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 W HIGHWAY 74",
            "address_2": "SUITE F",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793468",
            "telephone_number": "704-246-2900",
            "fax_number": "704-246-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS PHYSICIANS NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901967",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - BLUE SHIELD",
            "identifier": "017GY",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB120",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Trail Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indian Trail, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.