Individual provider Active NPI

Carey Gordon Cottle Jr., MD

  • Psychiatry Physician
  • Greensboro, NC
National Provider Identifier
1881786267
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
39167MEDICAL Issued in NC
Practice address
445 Dolley Madison Rd Ste 410
Greensboro, NC 27410-5167
Phone
(336) 292-1510
Fax
(336) 292-0679
NPI assigned
Sep 29, 2006
Last updated
Jul 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 39167MEDICAL NC Primary

Addresses

Primary practice location

445 Dolley Madison Rd Ste 410
Greensboro, NC 27410-5167

Mailing address

445 Dolley Madison Rd Ste 410
Greensboro, NC 27410-5167
Phone (336) 292-1510

Other identifiers 1

IdentifierTypeStateIssuer
24681OtherNCBCBS

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
I20111129000000 NC Practitioner - Psychiatry 4385674860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of North Carolina at Chapel Hill School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

445 Dolley Madison Rd
Suite 410
Greensboro, NC 27410-5167
Phone (336) 292-1510

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39167MEDICALNCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Cone Affiliated Physicians, Inc Current Accepting new patients
Moses Cone Affiliated Physicians, Inc. CurrentSince Jan 26, 2014 Accepting new patients
Moses Cone Affiliated Physicians, Inc Psychiatry CurrentSince Jan 26, 2014 Accepting new patients
Crossroads Psychiatric Group, PA Psychiatry Past Accepting new patients

Locations

1200 N Elm St
#5
Greensboro, NC 27401
Phone (336) 832-5777

445 Dolley Madison Rd
Ste 410
Greensboro, NC 27410
Phone (336) 292-1510

719 Green Valley Rd
Ste 305
Greensboro, NC 27408
Phone (336) 272-3696

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1881786267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 DOLLEY MADISON RD STE 410",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274105167",
            "telephone_number": "336-292-1510",
            "fax_number": "336-292-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 DOLLEY MADISON RD STE 410",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274105167",
            "telephone_number": "336-292-1510",
            "fax_number": "336-292-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTLE",
        "first_name": "CAREY",
        "middle_name": "GORDON",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "39167MEDICAL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "24681",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.