NPIMap

Organization Active NPI

Caromont Medical Group Inc

Doing business as Carolina Surgery

  • Surgery Physician
  • Gastonia, NC
National Provider Identifier
1760772826
Registry record updated Mar 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CAROMONT MEDICAL GROUP INC
Doing business as
Carolina Surgery
Practice address
1089 X Ray Dr
Gastonia, NC 28054-7489
Phone
(704) 864-8377
Fax
(704) 866-5206
NPI assigned
Apr 11, 2011
Last updated
Mar 28, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROMONT MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2012

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

Authorized official

Name
Randall L. Kelley
Title
President, Ceo
Phone
(704) 834-2133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

1089 X Ray Dr
Gastonia, NC 28054-7489

Mailing address

1089 X Ray Dr
Gastonia, NC 28054-7489
Phone (704) 864-8377

Other identifiers 1

IdentifierTypeStateIssuer
5917972MedicaidNC

Other names 1

  • Carolina Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000070 NC Part B Supplier - Clinic/Group Practice 3577476258 Receives reassigned benefits from 760 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Gastonia, NC; Kings Mountain, NC; Lenoir, NC; McAdenville, NC; Morganton, NC; Shelby, NC; Stanley, NC; Belmont, NC…

National Provider Directory

National Provider Directory
Part of
Caromont Medical Group in

Practitioners & affiliated clinicians

Practitioners 2

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": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1760772826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 X RAY DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547489",
            "telephone_number": "704-864-8377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 X RAY DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547489",
            "telephone_number": "704-864-8377",
            "fax_number": "704-866-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROMONT MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROMONT MEDICAL GROUP INC",
        "enumeration_date": "2011-04-11",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "704-834-2133"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917972",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; 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.