NPIMap

Organization Active NPI

Nirvana Hyperbaric Institute LLC

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Mooresville, NC
National Provider Identifier
1982203618
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
Legal business name
NIRVANA HYPERBARIC INSTITUTE LLC
Practice address
146 Medical Park Road
Suite 110
Mooresville, NC 28117
Phone
(704) 471-4100
Fax
(704) 471-4101
NPI assigned
Oct 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Roger L Hunter
Title
Director
Phone
(650) 642-0533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207PE0005X Primary

Addresses

Primary practice location

146 Medical Park Road
Suite 110
Mooresville, NC 28117

Mailing address

146 Medical Park Road
Suite 110
Mooresville, NC 28117
Phone (704) 471-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210602000054 NC Part B Supplier - Clinic/Group Practice 4587063136 Receives reassigned benefits from 4 practitioners
Practice locations: Mooresville, NC

National Provider Directory

National Provider Directory

Locations

146 Medical Park Rd
Ste 110
Mooresville, NC 28117
Phone (704) 471-4100

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1982203618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK ROAD",
            "address_2": "SUITE 110",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-471-4100",
            "fax_number": "704-471-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK ROAD",
            "address_2": "SUITE 110",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-471-4100",
            "fax_number": "704-471-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIRVANA HYPERBARIC INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-22",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-642-0533"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.