CMC-NORTHEAST, INC (NPI# 1467505016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467505016 |
| Entity Type | Organization |
| Organization Name | CMC-NORTHEAST, INC |
| Other Organization Name | NE PEDIATRIC NEUROLOGY, HUNTERSVILLE |
| Practice Address |
16623 Birkdale Pwky Suite 110, Ne Pediatric Neuro, Huntersville Huntersville NC 28078 |
| Practice Telephone | 7049874277 |
| Practice Fax Number | 7049875096 |
| Mailing Telephone | 7049874277 |
| Mailing Fax Number | 7049875096 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-08-22 |
| Authorized Official Name | FRIEDA M LOWDER (VP PHYSICIAN SERV) |
| Authorized Official Telephone | 7047834146 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0008X |
Pediatrics Specialization: Neurodevelopmental Disabilities |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | PARTNERS MEDICARE CHOICE | I912 | 01 |
| NC | BCBS GROUP ID | 015Y1 | 01 |
| NC | MAMSI | 3555573 | 01 |
| NC | TRICARE STANDARD, NON NWK | 566000156075 | 01 |
| NC | 5903854 | 05 | |
| NC | AETNA | 7837542 | 01 |
| Other Name | Type Code |
|---|---|
| NE Pediatric Neurology, Huntersville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376696062 | Cmc-northeast, Inc | Pediatrics | 16623 Birkdale Cmns Pkwy, Suite 110, Ne Pediatric Endo, Huntersville, NC 28078-5621 | 2007-01-18 |
| 1023313301 | Cmc-northeast, Inc | Pediatrics | 129 Woodson St, Suite D, Salisbury, NC 28144-3255 | 2011-01-19 |
| Street Address |
16623 BIRKDALE PWKY SUITE 110, NE PEDIATRIC NEURO, HUNTERSVILLE |
| City | HUNTERSVILLE |
| State | NC |
| Zip Code | 28078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538787718 | John M. Bakarich, Dds, Pllc | Dentist | 15810 Northcross Drive, Suite A, Huntersville, NC 28078 | 2020-07-14 |
| 1316587082 | Blake Allen Klessig | Chiropractor | 8936 Northpointe Executive Park Dr, Suite 195, Huntersville, NC 28078 | 2020-01-10 |
| 1922644830 | Steven James Underwood | Physical Therapist | Aldersgate Ccrc, 3800 Shamrock Drive, Charlotte, NC 28078 | 2019-11-26 |
| 1851856306 | Jessica Runnion | Behavior Technician | 14625 Reese Blvd, Apartment 208, Huntersville, NC 28078 | 2019-02-08 |
| 1568935401 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 111 Commerce Centre Drive, Suite 305, Huntersville, NC 28078 | 2019-01-03 |
| 1932691763 | Shakira Grier | Massage Therapist | 15905 Brookway Drive, Ste 4202, Huntersville, NC 28078 | 2018-06-06 |
| 1457850596 | Chudney Drew | Counselor | 10224 Hickorywood Hill Ave Ste 201, Huntersville, NC 28078 | 2018-02-05 |
| 1215457122 | Amy Nicole Castongia | Counselor | 10511 Drake Hill Dr, Huntersville, NC 28078 | 2017-06-21 |
| 1457714057 | Robin D Disbro | Registered Nurse | 6216 Colonial Garden Drive, Huntersville, NC 28078 | 2016-03-31 |
| 1144695545 | Huntersville H&r Ops Limited Partnership | Skilled Nursing Facility | 13835 Boren Street, Huntersville, NC 28078 | 2015-12-10 |
| Find all providers in zip 28078 | ||||
| Taxonomy Code | 2080P0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neurodevelopmental Disabilities |
| A pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427186113 | Thomas A St John | Pediatrics | 70 Holly Ln, Brevard, NC 28712-4783 | 2007-03-02 |
| 1699816017 | Liya Beyderman | Pediatrics | 6115 Park South Dr Ste 105, Charlotte, NC 28210-0104 | 2007-02-09 |
| 1013040666 | Shana Dale Wallace | Pediatrics | 1900 Randolph Rd, Suite 1010, Charlotte, NC 28207-1122 | 2007-03-13 |
| 1992734263 | Kristi L. Milowic | Pediatrics | 1520 Sunday Dr, Raleigh, NC 27607-5253 | 2006-06-30 |
| 1366409492 | Novant Medical Group, Inc | Pediatrics | 1900 Randolph Road, Suite 1010, Charlotte, NC 28207-1117 | 2006-05-01 |
| 1851353718 | Sasidharan Taravath | Pediatrics | 2131 S 17th St, Wilmington, NC 28401-7407 | 2006-04-05 |
| 1548230493 | Herminia De Guzman Ferreras | Pediatrics | 100 Medical Park Dr, Suite 310, Concord, NC 28025-2966 | 2006-01-24 |
| City | HUNTERSVILLE |
| Zip Code | 28078 |
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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.