Individual provider Active NPI

Kofi Asiedu, NP

  • Family Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1912374166
Registry record updated Aug 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5007858 Issued in NC
Practice address
10406 Cullen CT
Charlotte, NC 28278-8024
Phone
(704) 858-0660
NPI assigned
Aug 24, 2015
Last updated
Aug 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5007858 NC Primary

Addresses

Primary practice location

10406 Cullen CT
Charlotte, NC 28278-8024

Mailing address

10406 Cullen CT
Charlotte, NC 28278-8024
Phone (704) 858-0660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160713000634 SC Practitioner - Nurse Practitioner 6002108933 Reassigns benefits to 2 organizations
I20170712000816 NC Practitioner - Nurse Practitioner 6002108933 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caromont Medical Group IncGroup PAC ID 3577476258, shared by 2 NPIs, 425 clinicians

Practice addresses (Care Compare)

1200 Village Harbor Dr
Lake Wylie, SC 29710-9092

1895 Hoffman Rd
Suite B
Gastonia, NC 28054-6557
Phone (704) 861-8669

519 Nautical Dr
Clover, SC 29710-8113

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5007858NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Shiranee Jayasooriya Inc CurrentSince May 7, 2017 Accepting new patients
Caromont Medical Group Inc Current Accepting new patients
Caromont Medical Group Inc Current Accepting new patients
Caromont Medical Group, Inc. CurrentSince Jun 1, 2016 Accepting new patients
Gabbysco Home Care Agency, LLC Current Accepting new patients

Locations

1895 Hoffman Rd
#B
Gastonia, NC 28054
Phone (704) 861-8669

2240 Remount Rd
Gastonia, NC 28054
Phone (704) 671-5311

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

660 Summit Crossing Pl
Ste 301
Gastonia, NC 28054
Phone (704) 854-8799

3022 S Durango Dr
Ste 100
Las Vegas, NV 89117
Phone (702) 524-9858

1200 Village Harbor Dr
Lake Wylie, SC 29710
Phone (704) 671-6400

1200 Village Harbor Dr
Ste D
Lake Wylie, SC 29710
Phone (704) 671-6400

1795 Frank Gaston Blvd
Rock Hill, SC 29732
Phone (516) 849-8385

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1912374166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10406 CULLEN CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282788024",
            "telephone_number": "704-858-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10406 CULLEN CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282788024",
            "telephone_number": "704-858-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASIEDU",
        "first_name": "KOFI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-24",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5007858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.