Individual provider Active NPI

Renee Marie Stullich, MD

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
National Provider Identifier
1922685429
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
302840 Issued in NC
Practice address
Myers Park Clinic OB/GYN
1350 S. Kings Dr.
Charlotte, NC 28207
Phone
(704) 446-1544
Fax
(704) 446-1551
NPI assigned
Mar 29, 2021
Last updated
Mar 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 302840 NC Primary

Addresses

Primary practice location

Myers Park Clinic OB/GYN
1350 S. Kings Dr.
Charlotte, NC 28207

Mailing address

823 S Church St Apt 4307
Greenville, SC 29601-4744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251217003021 NC Practitioner - Obstetrics/Gynecology 7719380203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of South Carolina School of Medicine, Greenville, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

1025 Morehead Medical Dr
Charlotte, NC 28204-2963
Phone (704) 446-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
302840NCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Oct 6, 2025 Accepting new patients
Carolinas Physicians Network Inc Obstetrics & Gynecology CurrentSince Oct 6, 2025 Accepting new patients

Locations

1025 Morehead Medical Dr
Charlotte, NC 28204
Phone (704) 355-4455

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

7810 Providence Rd
Charlotte, NC 28226
Phone (704) 446-7800

Interoperability endpoints

  • Direct secure messaging: rstullich630852@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

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 6

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": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1922685429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 S CHURCH ST APT 4307",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296014744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MYERS PARK CLINIC OB/GYN",
            "address_2": "1350 S. KINGS DR.",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28207",
            "telephone_number": "704-446-1544",
            "fax_number": "704-446-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STULLICH",
        "first_name": "RENEE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "302840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.