| Ballantyne Medical Associates Pllc | |
|
12311 Copper Way Suite 100 Charlotte NC 28277-3386 | |
| (704) 540-1640 | |
| (704) 540-1639 |
| Full Name | Ballantyne Medical Associates Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 12311 Copper Way, Charlotte, North Carolina |
| Authorized Official Name and Position | Steven Robert Bauer (PRESIDENT) |
| Authorized Official Contact | 7045401640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ballantyne Medical Associates Pllc 12311 Copper Way Suite 100 Charlotte NC 28277-3386 Ph: (704) 540-1640 | Ballantyne Medical Associates Pllc 12311 Copper Way Suite 100 Charlotte NC 28277-3386 Ph: (704) 540-1640 |
| NPI Number | 1184776130 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/18/2011 |
| Medicare PECOS PAC ID | 6305949223 |
|---|---|
| Medicare Enrollment ID | O20070314000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184776130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2006-01723 (North Carolina) | Primary |
| Provider Name | Matthew Daniel Acampora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497728174 PECOS PAC ID: 1254381999 Enrollment ID: I20050131000143 |
| Provider Name | Steven Bauer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053402875 PECOS PAC ID: 1153234976 Enrollment ID: I20070314000440 |
| Provider Name | Godwin O Uzomba |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659376051 PECOS PAC ID: 2860526829 Enrollment ID: I20100813000137 |
| Provider Name | Ashleigh Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972931061 PECOS PAC ID: 0345581872 Enrollment ID: I20190410003040 |
| Provider Name | Kelly M De Groot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538753983 PECOS PAC ID: 3870988264 Enrollment ID: I20220322001661 |
| Provider Name | Esther O Adedokun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285379081 PECOS PAC ID: 8820477425 Enrollment ID: I20220805001677 |
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