NPIMap

Organization Active NPI

Orthocarolina, PA

  • Orthopaedic Surgery Physician
  • Clemmons, NC
National Provider Identifier
1972929297
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
38865 Issued in NC
Legal business name
ORTHOCAROLINA, PA
Practice address
3311 Jessie Village Drive
Clemmons, NC 27012
Phone
(336) 659-4135
Fax
(336) 794-3598
NPI assigned
Mar 11, 2014
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Mr. Brent Shear
Title
Cfo
Phone
(704) 323-2222

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 38865 NC
Orthopaedic Surgery Physician 207X00000X 38865 NC Primary
Orthopaedic Hand Surgery Physician 207XS0106X 38865 NC
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 38865 NC
Orthopaedic Surgery of the Spine Physician 207XS0117X 38865 NC
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 38865 NC
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 38865 NC
Physical Therapist 225100000X 38865 NC
Occupational Therapist 225X00000X 38865 NC
Pediatric Orthopaedic Surgery Physician 207XP3100X 38865 NC

Addresses

Primary practice location

3311 Jessie Village Drive
Clemmons, NC 27012

Mailing address

PO Box 117444
Atlanta, GA 30368-7444
Phone (704) 323-2250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031122000126 NC Part B Supplier - Clinic/Group Practice 2062316821 Receives reassigned benefits from 484 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Kernersville, NC; King, NC; Laurinburg, NC; Lincolnton, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Pembroke, NC…
O20140826000507 NC DME Supplier - Physician - General Practice 2062316821 Practice locations: Clemmons, NC

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Orthopedics31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

2265 Lewisville Clemmons Rd
Ste C
Clemmons, NC 27012
Phone (336) 712-0660

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1972929297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117444",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303687444",
            "telephone_number": "704-323-2250",
            "fax_number": "704-945-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 JESSIE VILLAGE DRIVE",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "27012",
            "telephone_number": "336-659-4135",
            "fax_number": "336-794-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOCAROLINA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "SHEAR",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-323-2222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "38865",
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "38865",
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "NC",
            "license": "38865",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.