Carolinas Medical Center-Northeast

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CAROLINAS MEDICAL CENTER-NORTHEAST

Doing business as

Northside Internal Medicine

Practice address

319 Penny LN
Suite a
Concord, NC 28025-1221

Phone

(704) 403-7575

Fax

(704) 403-4326

NPI assigned

Jan 27, 2011

Last updated

Jul 31, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

CAROLINAS MEDICAL CENTER-NORTHEASTAs reported in NPPES

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

Authorized official

Name

Frieda M Lowder

Title

Sr VP

Phone

(704) 403-4146

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Northside Internal Medicine Doing business as

Part of

CMC - Northeast Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Carolinas Medical Center-Northeast

  • Internal Medicine Physician
  • Concord, NC
  • NPI 1740241801
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Walter Lee Fanning Jr., M.D.

  • Infectious Disease Physician
  • Concord, NC
  • NPI 1639146780
  NPD (past)
• Robert Moser, MD

  • Internal Medicine Physician
  • Kannapolis, NC
  • NPI 1023080934
  NPD (past)

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

{
    "created_epoch": "1296086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1881990687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 PENNY LN",
            "address_2": "SUITE A",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251221",
            "telephone_number": "704-403-7575",
            "fax_number": "704-403-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 PENNY LN",
            "address_2": "SUITE A",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251221",
            "telephone_number": "704-403-7575",
            "fax_number": "704-403-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER-NORTHEAST",
        "enumeration_date": "2011-01-27",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "LOWDER",
        "authorized_official_first_name": "FRIEDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP",
        "authorized_official_telephone_number": "704-403-4146"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN, GROUP",
            "identifier": "232009",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916552",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolinas Medical Center-Northeast (Occupational Medicine Services)
• Carolinas Medical Center-Northeast (Carolinas Pediatric Neurology Care - Concord)
• Carolinas Medical Center-Northeast (Northeast Neurology)
• Carolinas Medical Center-Northeast
• Carolinas Medical Center-Northeast (Carolina Pediatric Gastroenterology)
• Carolinas Medical Center-Northeast (Northeast Internal and Integrative Medicine)
• Carolinas Physicians Network Inc (Atrium Health Primary Care Cabarrus Family Medicine)
• Carolinas Physicians Network Inc (Atrium Health Women's Care Copperfield OB/GYN)
• Carolinas Physicians Network Inc (Atrium Health Primary Care Christopherson Family Medicine)
• Carolinas Physicians Network Inc (Atrium Health Primary Care Cabarrus Family Medicine)

• Internal Medicine Physician in Concord, NC
• Providers in Concord, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.