Individual provider Active NPI

Kendra Rene Richardson, MD

  • Family Medicine Physician
  • Mount Holly, NC
National Provider Identifier
1932511078
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2015-01954 Issued in NC
Practice address
215 S Main St
Ste 100
Mount Holly, NC 28120-1620
Phone
(704) 302-8555
NPI assigned
May 23, 2014
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2015-01954 NC Primary
Sleep Medicine (Family Medicine) Physician 207QS1201X 2015-01954 NC
Sleep Medicine (Internal Medicine) Physician 207RS0012X 2015-01954 NC

Addresses

Primary practice location

215 S Main St
Ste 100
Mount Holly, NC 28120-1620

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

101 E W T Harris Blvd
Ste 3301-B
Charlotte, NC 28262-3485
Phone (704) 302-8555

Other practice location 2

10650 Park Rd
Ste 330
Charlotte, NC 28210-8538
Phone (704) 302-8555

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address krichardson1236670@CarolinasHealthcareSystem.direct-ci.com Atrium Health

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
I20170929002634 NC Practitioner - Family Practice 5092094383 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Meharry Medical College School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

215 S Main St
Suite 100
Mt Holly, NC 28120-1620
Phone (704) 302-8555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015-01954NCMDSleep Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Caromont Medical Group Inc Family Medicine Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 5, 2023 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Caromont Medical Group Inc Family Medicine CurrentSince Aug 21, 2017 Accepting new patients
Carolinas Physicians Network Inc Sleep Medicine CurrentSince Sep 5, 2023 Accepting new patients
Carolinas Physicians Network Inc. Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

101 E Wt Harris Blvd
Ste 3301B
Charlotte, NC 28262

10650 Park Rd
Ste 330
Charlotte, NC 28210
Phone (704) 468-8877

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

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

2001 Vail Ave
Fl 4
Charlotte, NC 28207
Phone (704) 304-7000

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

215 S Main St
Ste 100
Mt Holly, NC 28120

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

Interoperability endpoints

  • Direct secure messaging: krichardson1236670@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 1

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": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1932511078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 S MAIN ST",
            "address_2": "STE 100",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281201620",
            "telephone_number": "704-302-8555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 3301-B",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-302-8555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_2": "Ste 330",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-302-8555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KENDRA",
        "middle_name": "RENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-23",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2015-01954",
            "primary": true
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sleep Medicine",
            "state": "NC",
            "license": "2015-01954",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NC",
            "license": "2015-01954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krichardson1236670@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "215 S Main St",
            "address_2": "Ste 100",
            "city": "Mount Holly",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281201620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Holly, NC

Sources for this page

Verify at the official NPI Registry.