Organization Active NPI

Mecklenburg Medical Group

Doing business as Atrium Health Primary Care Mecklenburg Medical Group

Dermatology Physician
Charlotte, NC

National Provider Identifier

1962728923

Registry record updated Mar 9, 2023

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Charlotte, NC
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Dermatology PhysicianTaxonomy code 207N00000X
Legal business name: MECKLENBURG MEDICAL GROUP
Doing business as: Atrium Health Primary Care Mecklenburg Medical Group
Mecklenburg Medical Group (MMG)
Practice address: 200 S College St
Ste 500
Charlotte, NC 28202-2012
Phone: (704) 302-8800
NPI assigned: Apr 15, 2010
Last updated: Mar 9, 2023By the provider in NPPES
Organization subpart: Yes
Parent organization: MECKLENBURG MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name: Scott Rissmiller
Title: Enterprise Evp
Phone: (704) 355-8675

Specialties & licenses 13

Specialty (taxonomy)	Code	State	Primary
Dermatology Physician	207N00000X	NU	Primary
Internal Medicine Physician	207R00000X	NU
Cardiovascular Disease Physician	207RC0000X	NU
Endocrinology, Diabetes & Metabolism Physician	207RE0101X	NU
Gastroenterology Physician	207RG0100X	NU
Geriatric Medicine (Internal Medicine) Physician	207RG0300X	NU
Hematology & Oncology Physician	207RH0003X	NU
Infectious Disease Physician	207RI0200X	NU
Pulmonary Disease Physician	207RP1001X	NU
Rheumatology Physician	207RR0500X	NU
Medical Oncology Physician	207RX0202X	NU
Obesity Medicine (Internal Medicine) Physician	207RB0002X	NU
Sleep Medicine (Internal Medicine) Physician	207RS0012X	NU

Addresses

Primary practice location

200 S College St
Ste 500
Charlotte, NC 28202-2012

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 2

Atrium Health Primary Care Mecklenburg Medical Group Doing business as
Mecklenburg Medical Group (MMG) Doing business as

Electronic endpoints 2

Type	Endpoint	Use	Affiliation
CONNECT URL	https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service	Other	ABILITY Network
Direct Messaging Address	Ambulatory@direct.carolinashealthcare.org		Atrium Health

National Provider Directory

Part of: Mecklenburg Medical Group

NPI Registry JSON

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

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1962728923",
    "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",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S COLLEGE ST",
            "address_2": "STE 500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022012",
            "telephone_number": "704-302-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECKLENBURG MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MECKLENBURG MEDICAL GROUP",
        "enumeration_date": "2010-04-15",
        "last_updated": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "RISSMILLER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ENTERPRISE EVP",
        "authorized_official_telephone_number": "704-355-8675"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NU",
            "license": null,
            "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": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "200 S College St",
            "address_2": "Ste 500",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282022012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Primary Care Mecklenburg Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mecklenburg Medical Group (MMG)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.