NPIMap

Organization Active NPI

Caromont Health Services, Inc.

Doing business as CaroMont Specialty Surgery

  • Ambulatory Surgical Clinic/Center
  • Gastonia, NC
National Provider Identifier
1902895675
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
AS0037 Issued in NC
Legal business name
CAROMONT HEALTH SERVICES, INC.
Doing business as
CaroMont Specialty Surgery
Practice address
2511 Court Dr
Gastonia, NC 28054-2140
Phone
(704) 671-5600
NPI assigned
Oct 17, 2005
Last updated
Aug 29, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Mr. David O'Connor
Title
VP Chief Financial Officer
Phone
(704) 834-2049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X AS0037 NC Primary

Addresses

Primary practice location

2511 Court Dr
Gastonia, NC 28054-2140

Mailing address

2511 Court Dr
Gastonia, NC 28054-2140
Phone (704) 671-5600

Other identifiers 9

IdentifierTypeStateIssuer
0734076003OtherNCCIGNA
00632OtherNCBLUE CROSS
0585105OtherNCAETNA
3409852MedicaidNC
ASC002MedicaidSC
5040770OtherNCUNITED HEALTHCARE
3697OtherNCWELLPATH
312280OtherNCFEDERAL BLACK LUNG
371708500OtherNCDEPARTMENT OF LABOR

Other names 1

  • CaroMont Specialty Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050114000100 NC Part B Supplier - Ambulatory Surgical Center 2860441052 1 other NPI on this enrollment
Practice locations: Belmont, NC; Gastonia, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Caromont Specialty SurgeryCCN 34C0001101
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2031199Caromont Specialty Surgery2511 Court Drive, Gastonia, NC 28054Certificate of waiverOct 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Caromont Specialty Surgery5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Courtland TerraceGastonia, NC, CCN 345350 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 May 24, 1984
May 24, 1984
Feb 20, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1902895675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-671-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-671-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROMONT HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "704-834-2049",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "AS0037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0734076003",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00632",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0585105",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409852",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ASC002",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5040770",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLPATH",
            "identifier": "3697",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "312280",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "371708500",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CaroMont Specialty Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.