CMC-NORTHEAST, INC. (NPI# 1679512677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679512677 |
| Entity Type | Organization |
| Organization Name | CMC-NORTHEAST, INC. |
| Other Organization Name | CAROLINA PEDIATRIC SURGERY |
| Practice Address |
100 Medical Park Dr Suite 310 -carolina Pediatric Surgery Concord NC 28025-2966 |
| Practice Telephone | 7044032660 |
| Practice Fax Number | 7044032670 |
| Mailing Telephone | 7044032660 |
| Mailing Fax Number | 7044032670 |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-11-15 |
| Authorized Official Name | FRIEDA M LOWDER (VP PHYSICIAN SERVICES) |
| Authorized Official Telephone | 7044034146 |
| Is Organization Subpart | Y |
| Parent Organization Name | CMC-NORTHEAST, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | AETNA | 7878267 | 01 |
| NC | BCBS EFF 7-1-07 | 019FN | 01 |
| NC | TRICARE | 241255803 | 01 |
| NC | MAMSI | 355573 | 01 |
| NC | 5901473 | 05 | |
| NC | RAILROAD MEDICARE PTAN | DF8926 | 01 |
| SC | QPB706 | 05 | |
| NC | 5906961 | 05 | |
| NC | BCBS EFF PRIOR TO 7-1-07 | 017CP | 01 |
| Other Name | Type Code |
|---|---|
| CAROLINA PEDIATRIC SURGERY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043525280 | Cmc-northeast, Inc. | Psychiatry & Neurology | 6600 Wilkinson Blvd, Carolinas Pediatric Neurology Care - Holy Angels, Belmont, NC 28012-2796 | 2010-08-12 |
| 1184777617 | Cmc-northeast, Inc. | Counselor | 105 Yadkin Street, Suite 302, Albemarle, NC 28001-3454 | 2007-01-19 |
| 1497716989 | Cmc-northeast, Inc. | Internal Medicine | 219 Le Phillip Ct Ne, Northeast Lung Associates, Concord, NC 28025-2900 | 2006-04-01 |
| 1841595121 | Cmc-northeast, Inc. | Pediatrics | 129 Woodson St, Suite C, Salisbury, NC 28144-3255 | 2011-01-19 |
| 1669777942 | Cmc-northeast, Inc. | Psychiatry & Neurology | 129 Woodson St, Suite B, Salisbury, NC 28144-3255 | 2011-01-19 |
| 1093010407 | Cmc-northeast, Inc. | Pediatrics | 129 Woodson St, Suite A, Salisbury, NC 28144-3255 | 2011-01-14 |
| 1972806321 | Cmc-northeast, Inc. | Psychiatry & Neurology | 1001 Blythe Blvd, Suite 200 Cpnc - Charlotte Specialty Center, Charlotte, NC 28203-5866 | 2010-12-07 |
| 1174823900 | Cmc-northeast, Inc. | Psychiatry & Neurology | 2550 Court Dr, Suite 203, Gastonia, NC 28054-2152 | 2010-10-27 |
| 1831407295 | Cmc-northeast, Inc. | Internal Medicine | 920 Church St N, Northeast Transition of Care, Concord, NC 28025-2927 | 2010-09-20 |
| 1033424270 | Cmc-northeast, Inc. | Psychiatry & Neurology | 1781 Tate Blvd Se, Carolinas Pediatric Neurology Care - Hickory, Hickory, NC 28602-4251 | 2010-08-12 |
| Street Address |
100 MEDICAL PARK DR SUITE 310 -CAROLINA PEDIATRIC SURGERY |
| City | CONCORD |
| State | NC |
| Zip Code | 28025-2966 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700882958 | Patrick Anonick | Internal Medicine | 100 Medical Park Dr, Ste 210, Concord, NC 28025-2948 | 2005-06-22 |
| 1538700620 | Ashley Stewart | Nurse Practitioner | 100 Medical Park Dr, Ste 210, Concord, NC 28025-2948 | 2019-10-01 |
| 1659858330 | Krista Diiorio | Nurse Practitioner | 100 Medical Park Dr, Suite 310, Concord, NC 28025-2948 | 2018-07-25 |
| 1255829768 | Jessica Beal | Physician Assistant | 100 Medical Park Dr, Ste 110, Concord, NC 28025-2948 | 2018-04-30 |
| 1093216244 | Chris Larck | Pharmacist | 100 Medical Park Dr, Concord, NC 28025-2948 | 2018-02-23 |
| 1164948022 | Kathleen Bloom | Nurse Practitioner | 100 Medical Park Dr, Ste 210, Concord, NC 28025-2948 | 2017-08-22 |
| 1043736713 | Lauren Cartwright | Physician Assistant | 100 Medical Park Dr, Ste 210, Concord, NC 28025-2948 | 2017-08-15 |
| 1013439892 | Brittany Dillon | Nurse Practitioner | 100 Medical Park Dr, Suite 310, Concord, NC 28025-2948 | 2017-07-12 |
| 1932650892 | Kevin Hixson | Physician Assistant | 100 Medical Park Dr, Ste 210, Concord, NC 28025-2948 | 2016-10-17 |
| 1891243929 | Scott Palmer | Nurse Practitioner | 100 Medical Park Dr, Ste 110, Concord, NC 28025-2948 | 2016-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053910729 | Renewed Mindset Therapeutic Services, Pllc | Social Worker | 349 Copperfield Blvd Suite L #334, Concord, NC 28025 | 2020-10-22 |
| 1194284380 | Carolinas Physicians Network Inc | Internal Medicine | 610 Alfred Brown Jr. Court, Concord, NC 28025 | 2019-03-18 |
| 1164913596 | Damarius Raymond Faggart | Counselor | 503 Amhurst Drive, Concord, NC 28025 | 2018-05-22 |
| 1437677085 | Kathryn Emily Kanauer | Counselor | 280 Executive Park Dr Ne, Concord, NC 28025 | 2017-09-05 |
| 1649794439 | Foster Health & Homecare, LLC | Home Health | 363 Church Street North, Suite 260-i, Concord, NC 28025 | 2017-08-02 |
| 1326569336 | Jessie Leigh Tilley-compton | Social Worker | 371 Amhurst St Sw, Concord, NC 28025 | 2017-06-29 |
| 1609305663 | Sarah Katherine Thompson | Licensed Practical Nurse | 248 Executive Park Dr, Concord, NC 28025 | 2017-06-05 |
| 1023463098 | Kiera Brown | Social Worker | 219 Lephillip Court, Concord, NC 28025 | 2016-04-27 |
| 1992169445 | Brittiny N. Ingram Vanterpool | Counselor | 250 Branchview Dr Sw, Concord, NC 28025 | 2016-04-11 |
| 1215399852 | The Charlotte-mecklenburg Hospital Authority | Clinic/Center | 840 Warren C. Coleman Blvd, Concord, NC 28025 | 2016-03-23 |
| Find all providers in zip 28025 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730520396 | Carolinas Physicians Network Inc | Surgery | 100 Medical Park Dr, Ste 310, Concord, NC 28025-2948 | 2013-07-11 |
| 1184788853 | Northeast Surgical Specialties, LLC | Surgery | 920 Church St N, Northeast Surgical Specialties, LLC, Concord, NC 28025-2927 | 2006-12-20 |
| 1265499206 | Anthony Stallion | Surgery | 100 Medical Park Dr, Suite 310, Concord, NC 28025-2966 | 2006-04-26 |
| 1518953538 | Srikumar Pillai | Surgery | 100 Medical Park Dr, Suite 310 Carolina Pediatric Surgery, Concord, NC 28025-2948 | 2005-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225525538 | Jessica Marie Pierce | Surgery | 1900 Randolph Rd Ste 210, Charlotte, NC 28207-1106 | 2018-04-23 |
| 1750695078 | Pamela Artise Patrick-roberts | Surgery | N Carolina Baptist Hospital, Medical Center Blvd, Winston Salem, NC 27157-0001 | 2010-07-28 |
| 1346376423 | Daniel Andrew Bambini | Surgery | 1900 Randolph Rd., Ste. 210, Charlotte, NC 28207-1106 | 2007-02-26 |
| 1821085838 | Gregory Hoy | Surgery | 105 Wando Cir, Hertford, NC 27944-8951 | 2005-10-04 |
| 1982269346 | Wakemed Specialists Group, LLC | Surgery | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-05-01 |
| 1194157388 | Carolinas Physicians Network Inc | Surgery | 1025 Morehead Medical Dr, Ste 275, Charlotte, NC 28204-2963 | 2013-07-30 |
| 1134447378 | Carolina Healthcare Associates Inc | Surgery | 2131 S 17th St, Wilmington, NC 28401-7407 | 2010-05-12 |
| 1740441088 | Leah M Sieren | Surgery | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2008-06-19 |
| 1275741076 | Graham Harvey Cosper | Surgery | 1900 Randolph Rd., Ste. 210, Charlotte, NC 28207-1106 | 2007-05-18 |
| 1669691168 | Jeffrey Dehmer | Surgery | 2131 S 17th St, Wilmington, NC 28401-7407 | 2007-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.