NPIMap

Individual provider Active NPI

Maria Socorro Ambulo Geronimo, MD

  • Internal Medicine Physician
  • Matthews, NC
National Provider Identifier
1811097967
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2012-00713 Issued in NC
Practice address
630 Matthews Township Pkwy
Matthews, NC 28105-5322
Phone
(704) 495-6334
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2012-00713 NC Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 2012-00713 NC
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 25MA07879400 NJ

Addresses

Primary practice location

630 Matthews Township Pkwy
Matthews, NC 28105-5322

Mailing address

5960 Fairview Rd Ste 500
Charlotte, NC 28210-3113
Phone (704) 495-6334

Other practice location 1

332 N Trade St
Suite 2000
Matthews, NC 28105-1728
Phone (704) 302-8500

Other identifiers 5

IdentifierTypeStateIssuer
5920787MedicaidNC
1811097967MedicaidNC
0114821MedicaidNJ
NC1594MedicaidSC
25MA07879400OtherNJSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120716000028 NC Practitioner - Internal Medicine 0244231793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tryon Medical Partners, PLLCGroup PAC ID 7113277971, 139 clinicians
The Weston Group IncGroup PAC ID 8123936796, shared by 8 NPIs, 215 clinicians

Practice addresses (Care Compare)

630 Matthews Township Pkwy
Matthews, NC 28105-5322
Phone (704) 495-6334

7745 Little Ave
Charlotte, NC 28226-8168
Phone (704) 541-9333

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Charlotte, NC, CCN 347091
  • Adoration Home Health Home health agency, Charlotte, NC, CCN 347114
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Mint Hill Medical Center Hospital, Charlotte, NC, CCN 340190
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Atrium Health Union Hospital, Monroe, NC, CCN 340130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2012-00713NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tryon Medical Partners, PLLC Internal Medicine CurrentSince Sep 4, 2018 Accepting new patients
Medemerge P.a. Past Accepting new patients
The Heart Center of the Oranges Internal Medicine Past Accepting new patients

Locations

5950 Fairview Rd
Ste 330
Charlotte, NC 28210

5960 Fairview Rd
Ste 500
Charlotte, NC 28210

630 Matthews Township Pkwy
Matthews, NC 28105
Phone (704) 495-6020

Interoperability endpoints

  • Direct secure messaging: maria.geronimo.1@17847.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1811097967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 FAIRVIEW RD STE 500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103113",
            "telephone_number": "704-495-6334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MATTHEWS TOWNSHIP PKWY",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055322",
            "telephone_number": "704-495-6334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "332 N Trade St",
            "address_2": "Suite 2000",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281051728",
            "country_code": "US",
            "telephone_number": "704-302-8500",
            "fax_number": "704-302-8501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GERONIMO",
        "first_name": "MARIA SOCORRO",
        "middle_name": "AMBULO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2012-00713",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "2012-00713",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA07879400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5920787",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811097967",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114821",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1594",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "25MA07879400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

Verify at the official NPI Registry.