NPIMap

Organization Active NPI

Active Life Health of Charlotte PLLC

Doing business as Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • Charlotte, NC
National Provider Identifier
1770158909
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ACTIVE LIFE HEALTH OF CHARLOTTE PLLC
Doing business as
Arthritis Knee Pain Centers
Practice address
8401 Medical Plaza Dr Ste 355
Charlotte, NC 28262-9718
Phone
(704) 272-3884
Fax
(704) 235-1629
NPI assigned
May 20, 2021
Last updated
May 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Authorized official

Name
John J Rush, MDNPI 1851337281
Title
Chairman & Chief Executive Officer
Phone
(614) 504-0741

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

8401 Medical Plaza Dr Ste 355
Charlotte, NC 28262-9718

Mailing address

8401 Medical Plaza Dr Ste 355
Charlotte, NC 28262-9718
Phone (704) 272-3884

Other names 1

  • ARTHRITIS KNEE PAIN CENTERS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210804002313 NC DME Supplier - Physician - General Practice 9436551280 Practice locations: Charlotte, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

8401 Medical Plaza Dr
Ste 355
Charlotte, NC 28262
Phone (704) 272-3884

Practitioners & affiliated clinicians

Practitioners 8

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": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1770158909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR STE 355",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629718",
            "telephone_number": "704-272-3884",
            "fax_number": "704-235-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR STE 355",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629718",
            "telephone_number": "704-272-3884",
            "fax_number": "704-235-1629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE HEALTH OF CHARLOTTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHAIRMAN & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "614-504-0741",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ARTHRITIS KNEE PAIN CENTERS",
            "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 May 20, 2021; 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.