Faith Medical Center P.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

200401292 Issued in NC

Legal business name

FAITH MEDICAL CENTER P.C.

Practice address

3626 Latrobe Dr
Charlotte, NC 28211-1388

Phone

(704) 366-7182

Fax

(704) 366-7184

NPI assigned

Mar 25, 2009

Organization subpart

No

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

Authorized official

Name

Joel A Onafowokan, MDNPI 1790745495

Title

Medical Director

Phone

(704) 771-8400

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: joelonafowokan@faith.allscriptsdirect.net

Practitioners 3

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

• Joel A Onafowokan, MD

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1790745495

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Ambrosha Nicole Jordan, FNP

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1700027307
  Medicare reassignment NPD
• Chidinma Oligbo

  • Family Nurse Practitioner
  • Charlotte, NC
  • NPI 1023885944
  Medicare reassignment NPD

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1992947766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 LATROBE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111388",
            "telephone_number": "704-366-7182",
            "fax_number": "704-366-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3626 LATROBE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111388",
            "telephone_number": "704-366-7182",
            "fax_number": "704-366-7184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Medical Park Rd Ste 303",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281178541",
            "country_code": "US",
            "telephone_number": "704-677-7547",
            "fax_number": "980-444-0863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAITH MEDICAL CENTER P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "ONAFOWOKAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "704-771-8400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "200401292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902366",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF NORTH CAROLINA",
            "identifier": "1406K",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "joelonafowokan@faith.allscriptsdirect.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3626 Latrobe Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282111388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Spencer Faircloth
• Victor Rashad Fairley-Freeman, PT, DPT
• Fairmont Home Care
• Fairview Psychological Services, P.a.
• Faith Hope Love Services
• Faith Prosthetic-Orthotic Services Inc.
• Faith Residential Homes LLC
• Faith Works Foundation
• Faith,Hope& Charity Community Development Inc.
• Faithful & True Global Healthcare Staffing, PLLC

• Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.