Individual provider Active NPI

Martin Lo Sasso III, MD

  • Vascular Surgery Physician
  • Charlotte, NC
National Provider Identifier
1881252971
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
2024-02068 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203
Phone
(201) 478-0819
NPI assigned
Jun 3, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X 2024-02068 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203

Mailing address

730 Hawthorne LN Apt 456
Charlotte, NC 28204-2182

Other practice location 1

730 Hawthorne Ln Apt 456
Charlotte, NC 28204-2182
Phone (201) 470-0819

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241216003879 NC Order and Referring Only - General SurgeryPractitioner - General Surgery 4688901457

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Rowan University School of Osteopathic Medicine, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2490 Riverside Dr
Suite B
Macon, GA 31204-1788

575 1St St
Macon, GA 31201-2893

Hospital & facility affiliations

  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2024-02068NCMDVascular Surgery Physician

Interoperability endpoints

  • Direct secure messaging: mlosassoiii2899600@carolinashealthcaresystem.direct-ci.com

Hospital & facility affiliations 6

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": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1881252971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 HAWTHORNE LN APT 456",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28203",
            "telephone_number": "201-478-0819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 Hawthorne Ln Apt 456",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042182",
            "country_code": "US",
            "telephone_number": "201-470-0819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LO SASSO",
        "first_name": "MARTIN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "NC",
            "license": "2024-02068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.