NPIMap

Organization Active NPI

Centerwell Senior Primary Care NC JV PC

Doing business as CenterWell Senior Primary Care- Wilkinson

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1831836758
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE NC JV PC
Doing business as
CenterWell Senior Primary Care- Wilkinson
Practice address
3512 Wilkinson Blvd Ste 130
Charlotte, NC 28208-5698
Phone
(980) 999-2964
Fax
(877) 691-5325
NPI assigned
May 13, 2022
Last updated
Jan 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE NC JV PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

3512 Wilkinson Blvd Ste 130
Charlotte, NC 28208-5698

Mailing address

4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120

Other names 2

  • CenterWell Senior Primary Care- Wilkinson Doing business as
  • CenterWell Senior Primary Care NC PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171016002152 NC Part B Supplier - Clinic/Group Practice 2264708486 Receives reassigned benefits from 65 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burlington, NC; Gastonia, NC; Greensboro, NC; Winston Salem, NC
O20230315000375 NC Part B Supplier - Clinic/Group Practice 0345614384 Receives reassigned benefits from 59 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC; Raleigh, NC; Durham, NC; Asheville, NC

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2264859Centerwell Senior Primary Care-Wilkinson3512 Wilkinson Blvd. Suite 130, Charlotte, NC 28208Certificate of waiverJul 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Primary Care NC JV PC11 organizations share this tax ID, including this one
Part of
Partners in Primary Care NC

Other organizations with this tax ID 10

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

Locations

105 River Hills Rd
Ste A
Asheville, NC 28805
Phone (828) 998-1779

3512 Wilkinson Blvd
Ste 130
Charlotte, NC 28208
Phone (980) 999-2964

5415 South Blvd
Charlotte, NC 28217
Phone (704) 869-0321

4201 University Dr
Ste 101
Durham, NC 27707
Phone (984) 283-1722

2910 E Franklin Blvd
Ste 1
Gastonia, NC 28056
Phone (704) 648-0460

2910 E Franklin Blvd
Unit 1
Gastonia, NC 28056
Phone (704) 648-0460

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1831836758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 650",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396013",
            "telephone_number": "407-447-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 WILKINSON BLVD STE 130",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085698",
            "telephone_number": "980-999-2964",
            "fax_number": "877-691-5325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE NC JV PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE NC JV PC",
        "enumeration_date": "2022-05-13",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care- Wilkinson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CenterWell Senior Primary Care- Wilkinson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CenterWell Senior Primary Care NC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.