NPIMap

Organization Active NPI

Carolinas Medical Center

Doing business as Carolinas Back & Sports Specialists

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Charlotte, NC
National Provider Identifier
1891093613
Registry record updated Aug 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
CAROLINAS MEDICAL CENTER
Doing business as
Carolinas Back & Sports Specialists
Practice address
3030 Randolph Road
Suite 105
Charlotte, NC 28211-1365
Phone
(704) 512-4400
Fax
(704) 512-4401
NPI assigned
Mar 2, 2011
Last updated
Aug 10, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINAS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2016

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

Authorized official

Name
Mr. Thomas Ford Laymon
Title
SVP
Phone
(704) 631-0002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Spinal Cord Injury Medicine Physician 2081P0004X NU
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X NU Primary

Addresses

Primary practice location

3030 Randolph Road
Suite 105
Charlotte, NC 28211-1365

Mailing address

PO Box 601372
Charlotte, NC 28260-1372
Phone (704) 512-4400

Other identifiers 2

IdentifierTypeStateIssuer
NPB197MedicaidSC
5903972MedicaidNC

Other names 1

  • Carolinas Back & Sports Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Carolinas Mecical Ctr N69 organizations share this tax ID, including this one
Part of
Carolinas Mecical Ctr N

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1891093613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601372",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601372",
            "telephone_number": "704-512-4400",
            "fax_number": "704-512-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 RANDOLPH ROAD",
            "address_2": "SUITE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111365",
            "telephone_number": "704-512-4400",
            "fax_number": "704-512-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINAS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINAS MEDICAL CENTER",
        "enumeration_date": "2011-03-02",
        "last_updated": "2016-08-10",
        "status": "A",
        "authorized_official_last_name": "LAYMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "FORD",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "704-631-0002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB197",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903972",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolinas Back & Sports Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 10, 2016; 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.