Active NPI
Sandy Ghannam
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1881467884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001013703
- Practice address
- 2001 Vail Ave
Charlotte, NC 28207-1248 - Phone
- (704) 304-5000
- NPI assigned
- Nov 1, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001013703 | NC | Primary |
Addresses
Primary practice location
2001 Vail Ave
Charlotte, NC 28207-1248
Mailing address
7012 Waggoners Glen LN
Charlotte, NC 28226-3195
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001013703 | NC | MD | Physician Assistant |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Charlotte, NC
- NPI 1912232182
-
- Multi-Specialty Clinic/Center
- Statesville, NC
- NPI 1396216735
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1881467884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7012 WAGGONERS GLEN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282263195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 VAIL AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071248",
"telephone_number": "704-304-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANNAM",
"first_name": "SANDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-01",
"last_updated": "2023-11-01",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "001013703",
"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 Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.