NPIMap

Organization Active NPI

Geridoc LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Charlotte, NC
National Provider Identifier
1790812840
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
930069 Issued in NC
Legal business name
GERIDOC LLC
Practice address
4431 Montibello Dr
Charlotte, NC 28226-7420
Phone
(704) 564-9030
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

Name
Dr. Albert Shederick Ford Jr., M.D.
Title
Doctor
Phone
(704) 564-9030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X 930069 NC Primary

Addresses

Primary practice location

4431 Montibello Dr
Charlotte, NC 28226-7420

Mailing address

4431 Montibello Dr
Charlotte, NC 28226-7420
Phone (704) 564-9030

Other identifiers 2

IdentifierTypeStateIssuer
32996OtherNCBCBS
5909094MedicaidNC

National Provider Directory

National Provider Directory

Locations

63 Blackstock Rd
Inman, SC 29349
Phone 81224892069

Practitioners & affiliated clinicians

Practitioners 5

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": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1790812840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4431 MONTIBELLO DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282267420",
            "telephone_number": "704-564-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4431 MONTIBELLO DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282267420",
            "telephone_number": "704-564-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIDOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "SHEDERICK",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "704-564-9030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "930069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "32996",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909094",
            "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 Jun 30, 2008; 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.