NPIMap

Organization Active NPI

Charlotte Gastroenterology & Hepatology, PLLC

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
National Provider Identifier
1851548655
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC
Practice address
2015 Randolph Rd
Suite 101
Charlotte, NC 28207-1128
Phone
(704) 377-4009
NPI assigned
Aug 22, 2008
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Mrs. Jennifer Hicks
Title
Ceo
Phone
(704) 377-4009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2015 Randolph Rd
Suite 101
Charlotte, NC 28207-1128

Mailing address

2015 Randolph Rd
Suite 101
Charlotte, NC 28207-1128
Phone (704) 377-4009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070922000030 NC Part B Supplier - Ambulatory Surgical Center 3870489412 Receives reassigned benefits from 49 practitioners
Practice locations: Charlotte, NC

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Charlotte Gastroenterology and Hepatology PLLCCCN 34C0001148
Medicare certification status
ActiveFrom the Provider of Services file

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
34D0243945Charlotte Gastroenterology/Hepatology2015 Randolph Road Suite 208, Charlotte, NC 28207Certificate of waiverAug 31, 2026
34D2147544Charlotte Gastroenterology and Hepatology, PLLC2015 Randolph Road, Suite 101, Charlotte, NC 28207Certificate of waiverApr 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Gastro Hep3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

15830 Ballantyne Medical Pl
Ste 150
Charlotte, NC 28277

2015 Randolph Rd
Ste 208
Charlotte, NC 28207
Phone (704) 602-6544

6324 Fairview Rd
Ste 204
Charlotte, NC 28210

13808 Professional Center Dr
Huntersville, NC 28078
Phone (704) 717-5549

2000 Wellness Blvd
Ste 130
Monroe, NC 28110
Phone (704) 316-2154

150 Fairview Rd
Ste 120
Mooresville, NC 28117
Phone (704) 659-4499

Practitioners & affiliated clinicians

Practitioners 99

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 99

NPI Registry JSON

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1851548655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 RANDOLPH RD",
            "address_2": "SUITE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071128",
            "telephone_number": "704-377-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 RANDOLPH RD",
            "address_2": "SUITE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071128",
            "telephone_number": "704-377-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-377-4009",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 29, 2025; 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.