Heritage Regenerative Medicine Inc.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

HERITAGE REGENERATIVE MEDICINE INC.

Practice address

8058 Corporate Center Dr Ste 300
Charlotte, NC 28226-4560

Phone

(980) 210-0079

NPI assigned

Jan 20, 2025

Last updated

Jan 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Evans Stavrakos, MDNPI 1063426724

Title

Owner

Phone

(574) 386-1846

Specialties & licenses 1

Addresses

Locations

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.

• John Evans Stavrakos, MD

  • Physical Medicine & Rehabilitation Physician
  • West Columbia, SC
  • NPI 1063426724
  NPD Authorized official

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

{
    "created_epoch": "1737331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1932911773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8058 CORPORATE CENTER DR STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282264560",
            "telephone_number": "980-210-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8058 CORPORATE CENTER DR STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282264560",
            "telephone_number": "980-210-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE REGENERATIVE MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-20",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "STAVRAKOS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EVANS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-386-1846",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teal M Herendeen, OMT
• Heritage Home Care of Charlotte
• Heritage Home Care of Greensboro Inc. (Heritage Home Care Agency Inc.)
• Heritage Homecare of Gastonia
• Heritage House Human Services Inc
• Timothy Gordon Herlihy, OT/L
• Amanda Herlocker, M.S., R.D.N., L.D.N.
• Kalie Anne Herman, MS, RD
• Samantha Herman
• Spencer Hermansen, BS, BCABA

• Medical Specialty Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Medical Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; 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.