Central Pediatrics & Internal Medicine, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

211850 Issued in NC

Legal business name

CENTRAL PEDIATRICS & INTERNAL MEDICINE, PA

Practice address

3040 Eastway Drive Suite a
Charlotte, NC 28205

Phone

(980) 237-9130

Fax

(980) 237-8082

NPI assigned

Jul 16, 2015

Organization subpart

No

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

Authorized official

Name

Julius Tokunboh, M.D.NPI 1952410110

Title

Medical Director

Phone

(704) 817-7560

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Julius Kehinde Tokunboh, M.D.

  • Internal Medicine Physician
  • Concord, NC
  • NPI 1952410110

  Internal Medicine, NC

  Medicare reassignment NPD Authorized official
• Abelyn Agbai, FNP

  • Family Nurse Practitioner
  • Concord, NC
  • NPI 1447148978

  NC

  Medicare reassignment NPD
• Jayla Marie Caffey

  • Physician Assistant
  • Charlotte, NC
  • NPI 1891496824

  NC

  Medicare reassignment
• Sydney Thames Diakalela, PA-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1003500091

  NC

  Medicare reassignment
• Eden Asefaw Ghebresilasie, PA

  • Physician Assistant
  • North Miami Beach, FL
  • NPI 1164591400
  NPD (past)

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1871977249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 EASTWAY DRIVE SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28205",
            "telephone_number": "980-237-9130",
            "fax_number": "980-237-8082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 EASTWAY DRIVE SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28205",
            "telephone_number": "980-237-9130",
            "fax_number": "980-237-8082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PEDIATRICS & INTERNAL MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "TOKUNBOH",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "704-817-7560",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "211850",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "211850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Charlotte, NC
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.