Azemobo Charles Akhimien, MD
Individual provider Active NPI Internal Medicine Physician · Gastonia, NC
NPI 1992760581 · NPPES record last updated Dec 21, 2017
Key facts
- NPI
- 1992760581
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 200000171 (NC)
- Practice address
- 1021 X Ray Dr
Gastonia, NC 28054-7489 - Phone
- (704) 867-2341
- Fax
- (704) 867-9019
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051108000066 | NC | Practitioner - Internal Medicine |
5799703104 | Reassigns benefits to 1 organization |
| I20200213001048 | SC | Practitioner - Internal Medicine | 5799703104 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51287 | GA | MD | Internal Medicine Physician |
| 200000171 | NC | MD | Internal Medicine Physician |
| 23016 | SC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 24 On Physicians of SC, LLC | Current |
Accepting new patients | |
| Gastonia Medical Specialty Clinic PA | Internal Medicine | Current |
Accepting new patients |
| Sterling Hospitalist Services of North Carolina Inc. | Internal Medicine | Past | Accepting new patients |
Locations
2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662
1021 X Ray Dr
Gastonia, NC 28054
Phone (704) 867-2341
316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000
Interoperability endpoints
- charles.akhimien@gastoniamedical.directbygreenway.com
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61582
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 51287 | GA | |
| Internal Medicine Physician | 207R00000X | 200000171 | NC | Yes |
| Internal Medicine Physician | 207R00000X | 23016 | SC |
Addresses
Primary practice location
1021 X Ray Dr
Gastonia, NC 28054-7489
Mailing address
1021 X Ray Dr
Gastonia, NC 28054-7489
Phone (704) 867-2341
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891255W | Medicaid | NC |
Other providers in Gastonia, NC
- Alec Akbarov
- Akers Pharmacy
- Akers Pharmacy Inc
- Akers Pharmacy Inc
- Richard Edwin Akers
- Iyon Debbie Akhimien
- Funmilola Akingbala
- Cecilia Akintonde
- Joanne Frances Akong
- Alan a. Godel, D.D.S.
All providers in Gastonia, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.