Active NPI
McRandon Elvenstar
- Skilled Nursing Facility
- Monroe, NC
National Provider Identifier
1982137154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 2617
- Practice address
- 204 E Old Highway 74
Monroe, NC 28112-8122 - Phone
- (704) 283-3066
- NPI assigned
- Apr 5, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2617 | NC | Primary |
Addresses
Primary practice location
204 E Old Highway 74
Monroe, NC 28112-8122
Mailing address
7817 Surreywood PL
Charlotte, NC 28270-2161
Phone (704) 651-2509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2617 | NC | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491350400000",
"number": "1982137154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7817 SURREYWOOD PL",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282702161",
"telephone_number": "704-651-2509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 E OLD HIGHWAY 74",
"city": "MONROE",
"state": "NC",
"postal_code": "281128122",
"telephone_number": "704-283-3066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELVENSTAR",
"first_name": "MCRANDON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-05",
"last_updated": "2017-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NC",
"license": "2617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.