Active NPI
Edward Gale Loy Tautjo, MD
- Hospitalist Physician
- Charlotte, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 9701614
- Practice address
- 200 Hawthorne LN
Charlotte, NC 28204-2515 - Phone
- (704) 384-5416
- Fax
- (704) 384-5992
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 009701614 | NC | |
| Hospitalist Physician | 208M00000X | 9701614 | NC | Primary |
Addresses
Primary practice location
200 Hawthorne LN
Charlotte, NC 28204-2515
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-5416
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 195808 | Medicaid | SC | |
| 891354Y | Medicaid | NC |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | etautjo15128@direct.novanthealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10030 Gilead Rd
Huntersville, NC 28078-7545
2825 Lyndhurst Ave
Winston Salem, NC 27103-4146
3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200
5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572
Hospital & facility affiliations
- Novant Health Huntersville Medical Center
- Novant Health Presbyterian Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009701614 | NC | MD | Internal Medicine Physician |
| 9701614 | NC | MD | Hospitalist Physician |
| 19580 | SC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Presbyterian Hospital | Internal Medicine | Current | Accepting new patients |
| The Presbyterian Hospital | Internal Medicine | Current | Accepting new patients |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Mint Hill Medical Center, LLC | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Internal Medicine | Current | Accepting new patients |
| The Presbyterian Hospital | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Novant Health Matthews Medical Center LLC | Current | Accepting new patients |
Locations
1901 Randolph Rd
Charlotte, NC 28207
Phone (704) 316-2000
8201 Healthcare Loop
Charlotte, NC 28215
Phone (980) 302-1000
200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424
10030 Gilead Rd
Huntersville, NC 28078
Phone (704) 316-4000
1500 Matthews Township Pkwy
Matthews, NC 28105
Phone (704) 384-6500
5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441
175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811
2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300
Interoperability endpoints
- etautjo15128@direct.novanthealth.org
Organizations & group practices 8
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Neurology with Special Qualifications in Child Neurology Physician
- Charlotte, NC
- NPI 1366409492
-
- Specialist
- Matthews, NC
- NPI 1184782419
-
- Certified Registered Nurse Anesthetist
- Charlotte, NC
- NPI 1063910404
-
- Geriatric Medicine (Internal Medicine) Physician
- Charlotte, NC
- NPI 1053365817
-
- Hospitalist Physician
- Matthews, NC
- NPI 1225479793
Internal Medicine
-
- Obstetrics & Gynecology Physician
- Matthews, NC
- NPI 1386506137
-
- Specialist
- Charlotte, NC
- NPI 1245399542
-
- Internal Medicine Physician
- Charlotte, NC
- NPI 1740169820
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Huntersville, NC
- NPI 1346291309
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Charlotte, NC
- NPI 1396798591
Hospital
-
- Psychiatric Hospital Unit
- Charlotte, NC
- NPI 1497708838
-
- General Acute Care Hospital
- Charlotte, NC
- NPI 1881647204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675814400000",
"number": "1790786283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447",
"telephone_number": "704-384-5416",
"fax_number": "704-384-5992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWTHORNE LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042515",
"telephone_number": "704-384-5416",
"fax_number": "704-384-5992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAUTJO",
"first_name": "EDWARD",
"middle_name": "GALE LOY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2023-02-08",
"certification_date": "2023-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "009701614",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "NC",
"license": "9701614",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "195808",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891354Y",
"state": "NC"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "etautjo15128@direct.novanthealth.org",
"affiliation": "N",
"address_1": "200 Hawthorne Ln",
"city": "Charlotte",
"state": "NC",
"country_code": "US",
"postal_code": "282042515",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.