NPIMap

Organization Active NPI

Presbyterian Breast Center LLC

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1831452622
Registry record updated Jul 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PRESBYTERIAN BREAST CENTER LLC
Practice address
1718 E 4TH St
Suite 103
Charlotte, NC 28204-3261
Phone
(704) 384-5000
Fax
(704) 384-5654
NPI assigned
Jun 18, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Daniel J Schaefer
Title
Coo
Phone
(770) 300-0101

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 12

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

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20120917000839 NC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3577511542 Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Breast Center LLC (6 organizations share this tax ID)

Locations

10030 Gilead Rd
#310
Huntersville, NC 28078
Phone (704) 316-5535

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

NPPES NPI Registry

Primary practice location

1718 E 4TH St
Suite 103
Charlotte, NC 28204-3261

Mailing address

PO Box 603543
Charlotte, NC 28260-3543
Phone (678) 393-5600

Other names 1

NPPES NPI Registry
  • Novant Health Breast Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 10, 2017.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499644800000",
    "number": "1831452622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603543",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603543",
            "telephone_number": "678-393-5600",
            "fax_number": "770-300-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E 4TH ST",
            "address_2": "SUITE 103",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043261",
            "telephone_number": "704-384-5000",
            "fax_number": "704-384-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN BREAST CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-18",
        "last_updated": "2017-07-10",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-300-0101"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Breast Center",
            "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 Jul 10, 2017; 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.