NPIMap

Individual provider Active NPI

Charmeen Mack Wilkes, PA

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1982035358
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-04743 Issued in NC
Practice address
1350 S Kings Dr
Charlotte, NC 28207-2134
Phone
(704) 446-1255
NPI assigned
Dec 10, 2013
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-04743 NC Primary

Addresses

Primary practice location

1350 S Kings Dr
Charlotte, NC 28207-2134

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

100 Medical Park Dr
Ste 110
Concord, NC 28025-2948
Phone (704) 403-1370

Other practice location 2

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204-2990
Phone (980) 442-2000

Other practice location 3

15830 Ballantyne Medical Pl
Ste 200
Charlotte, NC 28277-4653
Phone (980) 442-9600

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cwilkes630670@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140402001265 NC Practitioner - Physician Assistant 3971734096 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

100 Medical Park Dr
Concord, NC 28025-2966

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 355-7328

2452 Fairlawn CT
Winston Salem, NC 27106-3884
Phone (336) 281-5965

275 Hwy 16 N
Suite 202
Denver, NC 28037-3002
Phone (704) 732-9843

445 S Kings Dr
Charlotte, NC 28204-3041
Phone (980) 308-0141

5303 Poplar Tent Rd
Suite 90
Concord, NC 28027-9720
Phone (980) 866-4493

920 Church St N
Concord, NC 28025-2927
Phone (704) 403-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-04743NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Medicorp Enterprises, LLC CurrentSince Oct 27, 2019 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Feb 6, 2023 Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2017 Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2017 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Feb 6, 2023 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Oct 27, 2019 Accepting new patients
Carolinas Medical Center CurrentSince Feb 6, 2023 Accepting new patients
Carolinas Medical Center CurrentSince Feb 6, 2023 Accepting new patients
Carolina Medicorp Enterprises Inc Physician Assistant Past Accepting new patients

Locations

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

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204
Phone (704) 355-2884

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

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

15830 Ballantyne Medical Pl
Ste 200
Charlotte, NC 28277
Phone (980) 442-9600

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150

6965 Fairview Rd
Charlotte, NC 28210
Phone (704) 631-1300

9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

100 Medical Park Dr
Ste 110
Concord, NC 28025
Phone (704) 403-1370

6030 W Highway 74
Ste A
Indian Trail, NC 28079
Phone (704) 246-2777

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

Interoperability endpoints

  • Direct secure messaging: cwilkes630670@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: cwilkes766223@direct.novanthealth.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 11

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": "1386633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1982035358",
    "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": "1350 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072134",
            "telephone_number": "704-446-1255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 110",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252948",
            "country_code": "US",
            "telephone_number": "704-403-1370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1021 Morehead Medical Dr",
            "address_2": "Ste A",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042990",
            "country_code": "US",
            "telephone_number": "980-442-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15830 Ballantyne Medical Pl",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774653",
            "country_code": "US",
            "telephone_number": "980-442-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKES",
        "first_name": "CHARMEEN",
        "middle_name": "MACK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-10",
        "last_updated": "2024-07-15",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwilkes630670@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1350 S Kings Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282072134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.