NPIMap

Organization Active NPI

First Foundation Clinic of the Carolinas, Inc.

  • Internal Medicine Physician
  • Dallas, NC
National Provider Identifier
1912968934
Registry record updated Aug 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.
Practice address
107 N Summey St
Dallas, NC 28034-1824
Phone
(704) 923-0446
Fax
(704) 923-8319
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2008

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

Authorized official

Name
Ms. Thirrfern Jamerson
Title
Office Manager
Phone
(704) 923-0446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

107 N Summey St
Dallas, NC 28034-1824

Mailing address

PO Box 578
Dallas, NC 28034-0578
Phone (704) 923-0446

Other identifiers 2

IdentifierTypeStateIssuer
0233UOtherNCBCBS
790233UMedicaidNC

National Provider Directory

National Provider Directory

Locations

4938 Central Ave
Charlotte, NC 28205
Phone (704) 567-0465

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219363200000",
    "number": "1912968934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "city": "DALLAS",
            "state": "NC",
            "postal_code": "280340578",
            "telephone_number": "704-923-0446",
            "fax_number": "704-923-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N SUMMEY ST",
            "city": "DALLAS",
            "state": "NC",
            "postal_code": "280341824",
            "telephone_number": "704-923-0446",
            "fax_number": "704-923-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2008-08-22",
        "status": "A",
        "authorized_official_last_name": "JAMERSON",
        "authorized_official_first_name": "THIRRFERN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "704-923-0446",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0233U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790233U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; 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.