Individual provider Active NPI

Bethany Marie Grubb, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1861754178
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-03542 Issued in NC
Practice address
128 E Park Ave Ste a
Charlotte, NC 28203-3720
Phone
(704) 750-8801
NPI assigned
Jun 12, 2012
Last updated
May 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-03542 NC Primary

Addresses

Primary practice location

128 E Park Ave Ste a
Charlotte, NC 28203-3720

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6241

Other practice location 2

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-7070

Other practice location 3

1000 Blythe Blvd
CMC Annex 1st Floor
Charlotte, NC 28203-5812
Phone (704) 355-0720

Other practice location 4

920 Church St N
Suite 255
Concord, NC 28025-2927
Phone (704) 403-1331

Other practice location 5

2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-6070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120910000473 NC Practitioner - Physician Assistant 6204084619 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1901 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 316-2000

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

2826 Randolph Rd
Charlotte, NC 28211-1386
Phone (704) 358-0308

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

4741 Randolph Rd
Charlotte, NC 28211-2919
Phone (704) 365-6730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-03542NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Jan 27, 2014 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 20, 2023 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 27, 2014 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 20, 2023 Accepting new patients
Columbus Regional Health Network CurrentSince Jan 27, 2013 Accepting new patients
Columbus Regional Health Network CurrentSince Jan 27, 2013 Accepting new patients
Scotland Regional Health Network CurrentSince Jan 27, 2014 Accepting new patients
Scotland Regional Health Network CurrentSince Jan 27, 2014 Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Columbus Regional Health Network Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1000 Blythe Blvd
Fl 1
Charlotte, NC 28203
Phone (704) 355-0720

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

920 Church St N
Ste 255
Concord, NC 28025
Phone (704) 403-1331

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

201 E Grover St
Shelby, NC 28150
Phone (704) 487-3000

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: bgrubb509629@direct.novanthealth.org

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 16

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1861754178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E PARK AVE STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282033720",
            "telephone_number": "704-750-8801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 N Tryon St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623300",
            "country_code": "US",
            "telephone_number": "704-863-6241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10628 Park Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108407",
            "country_code": "US",
            "telephone_number": "704-667-7070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Blythe Blvd",
            "address_2": "CMC Annex 1st Floor",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035812",
            "country_code": "US",
            "telephone_number": "704-355-0720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 Church St N",
            "address_2": "Suite 255",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252927",
            "country_code": "US",
            "telephone_number": "704-403-1331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Vail Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071248",
            "country_code": "US",
            "telephone_number": "704-304-6070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUBB",
        "first_name": "BETHANY",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.