NPIMap

Organization Active NPI

Charlotte Primary Care, PA

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1790762284
Registry record updated Jan 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
102928 Issued in NC
Legal business name
CHARLOTTE PRIMARY CARE, PA
Practice address
1918 Randolph Rd
Suite 440
Charlotte, NC 28207-1100
Phone
(704) 342-8115
Fax
(704) 344-2691
NPI assigned
Dec 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2010

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

Authorized official

Name
Dr. Kim Tam, MD
Title
President
Phone
(704) 342-8115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 102928 NC Primary

Addresses

Primary practice location

1918 Randolph Rd
Suite 440
Charlotte, NC 28207-1100

Mailing address

1918 Randolph Rd
Suite 440
Charlotte, NC 28207-1100
Phone (704) 342-8115

Other identifiers 1

IdentifierTypeStateIssuer
011Y5OtherNCBCBSNC PROVIDER ID#

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1790762284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "SUITE 440",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071100",
            "telephone_number": "704-342-8115",
            "fax_number": "704-344-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "SUITE 440",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071100",
            "telephone_number": "704-342-8115",
            "fax_number": "704-344-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE PRIMARY CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-342-8115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "102928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC PROVIDER ID#",
            "identifier": "011Y5",
            "state": "NC"
        }
    ],
    "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 Jan 6, 2010; 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.