Medical Plaza Family & Geriatric Physicians, PA

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

189833 Issued in NC

Legal business name

MEDICAL PLAZA FAMILY & GERIATRIC PHYSICIANS, PA

Practice address

8401 Medical Plaza Dr
Suite 365
Charlotte, NC 28262-8797

Phone

(704) 944-0975

Fax

(704) 943-0699

NPI assigned

Feb 6, 2013

Organization subpart

No

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

Authorized official

Name

Dr. William J Long, MDNPI 1992778906

Title

Physician/Owner

Phone

(704) 944-0975

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AFACCA

Practitioners 5

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

• William Long, M.D.

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1992778906
  Medicare reassignment Care Compare group NPD Authorized official
• Alvin Abaqueta, M.D.

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1235102187
  Medicare reassignment Care Compare group NPD
• Tilia Allen, FNP

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1942897095
  Medicare reassignment Care Compare group NPD
• Amy Hendricks Palacios, NP-C

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1851874200
  Medicare reassignment Care Compare group NPD
• Nichole Lowery Clontz, AGNP

  • Nurse Practitioner
  • Charlotte, NC
  • NPI 1912653742
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1360108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1851630172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR",
            "address_2": "SUITE 365",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628797",
            "telephone_number": "704-944-0975",
            "fax_number": "704-943-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR",
            "address_2": "SUITE 365",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628797",
            "telephone_number": "704-944-0975",
            "fax_number": "704-943-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PLAZA FAMILY & GERIATRIC PHYSICIANS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-06",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "704-944-0975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "189833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5922886",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Katelyn Brooke Medina, LCSW
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• Geriatric Medicine (Family Medicine) Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Geriatric Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.