Active NPI
Thalita Maria McDonough
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1730781469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-11079
- Practice address
- 332 Lillington Ave
Charlotte, NC 28204-3130 - Phone
- (704) 377-1216
- NPI assigned
- Nov 9, 2020
- Last updated
- May 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | ||
| Physician Assistant | 363A00000X | 0010-11079 | NC | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Rheumatology Physician | 207RR0500X | 001011079 | NC |
Addresses
Primary practice location
332 Lillington Ave
Charlotte, NC 28204-3130
Mailing address
332 Lillington Ave
Charlotte, NC 28204-3130
Phone (704) 377-1216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001011079 | NC | MD | Rheumatology Physician |
| 0010-11079 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joint and Muscle Medical Care | Rheumatology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Rheumatology Physician
- Charlotte, NC
- NPI 1528226529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1730781469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "332 LILLINGTON AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282043130",
"telephone_number": "704-377-1216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "332 LILLINGTON AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282043130",
"telephone_number": "704-377-1216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONOUGH",
"first_name": "THALITA MARIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-09",
"last_updated": "2021-05-19",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-11079",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "NC",
"license": "001011079",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.