| Carolina Digestive Pathology Lab | |
|
300 Billingsley Rd Ste 103 Charlotte NC 28211-1084 | |
| (704) 372-7974 | |
| (704) 372-8201 |
| Full Name | Carolina Digestive Pathology Lab |
|---|---|
| Speciality | Internal Medicine |
| Location | 300 Billingsley Rd Ste 103, Charlotte, North Carolina |
| Authorized Official Name and Position | Julie Rothrock (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 7043727974 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Digestive Pathology Lab Po Box 96314 Charlotte NC 28296-0314 Ph: (704) 372-7974 | Carolina Digestive Pathology Lab 300 Billingsley Rd Ste 103 Charlotte NC 28211-1084 Ph: (704) 372-7974 |
| NPI Number | 1124052444 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 11/02/2023 |
| Medicare PECOS PAC ID | 1951209790 |
|---|---|
| Medicare Enrollment ID | O20031230000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124052444 | NPI | - | NPPES |
| 7901569 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 40474 (North Carolina) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Phyllis Bourn Arthur |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1982648283 PECOS PAC ID: 6406755792 Enrollment ID: I20040106000402 |
| Provider Name | Dana B Pederson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1396787057 PECOS PAC ID: 7911892500 Enrollment ID: I20040223000041 |
| Provider Name | Stephen Stephenson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376561613 PECOS PAC ID: 3274518253 Enrollment ID: I20040623000476 |
| Provider Name | Peter J Honerkamp |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1659395333 PECOS PAC ID: 1557338373 Enrollment ID: I20040913000263 |
| Provider Name | Michael Dixon |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346260577 PECOS PAC ID: 4789644337 Enrollment ID: I20041018000683 |
| Provider Name | Lynda W Lewis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1053495481 PECOS PAC ID: 7012974017 Enrollment ID: I20041210000837 |
| Provider Name | Jason Alex Espada |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013932284 PECOS PAC ID: 6305895723 Enrollment ID: I20050112000958 |
| Provider Name | Fred C Fowler |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1326066705 PECOS PAC ID: 0749230787 Enrollment ID: I20050127000055 |
| Provider Name | Glen L Portwood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316965726 PECOS PAC ID: 0345274908 Enrollment ID: I20050922000789 |
| Provider Name | Kelly H Garmon |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1386677441 PECOS PAC ID: 1456364504 Enrollment ID: I20060713000289 |
| Provider Name | Jeffrey Brian Pitman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699794909 PECOS PAC ID: 2860490927 Enrollment ID: I20061128000233 |
| Provider Name | Eric B Thompson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1972521219 PECOS PAC ID: 8224130661 Enrollment ID: I20070302000484 |
| Provider Name | Ronnie Cyzner |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1528086980 PECOS PAC ID: 6305940818 Enrollment ID: I20070329000658 |
| Provider Name | Stephen Deal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598783961 PECOS PAC ID: 0042314551 Enrollment ID: I20070731000686 |
| Provider Name | Anthony David Colvin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831117324 PECOS PAC ID: 9133223647 Enrollment ID: I20070823000947 |
| Provider Name | Terri A Crockett |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073532743 PECOS PAC ID: 7315035250 Enrollment ID: I20071110000152 |
| Provider Name | Bruce Arakelian |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376580886 PECOS PAC ID: 1658459722 Enrollment ID: I20080415000779 |
| Provider Name | Geovanna O Deese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558534768 PECOS PAC ID: 5092884346 Enrollment ID: I20080513000533 |
| Provider Name | Joshua B Kish |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1225171622 PECOS PAC ID: 2466550595 Enrollment ID: I20080902000066 |
| Provider Name | Lisa Y Kimmerle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1124066881 PECOS PAC ID: 5294746368 Enrollment ID: I20091109000277 |
| Provider Name | Angela Angela Wilson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477739035 PECOS PAC ID: 1153403340 Enrollment ID: I20100128000657 |
| Provider Name | Tim D Wax |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1881686178 PECOS PAC ID: 0648303115 Enrollment ID: I20100804000501 |
| Provider Name | Barry Schneider |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1669490991 PECOS PAC ID: 4486758992 Enrollment ID: I20101023000016 |
| Provider Name | William Kendall Couch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1790080224 PECOS PAC ID: 2466634035 Enrollment ID: I20110303000727 |
| Provider Name | James R Osborne |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699078618 PECOS PAC ID: 6002098449 Enrollment ID: I20110307000862 |
| Provider Name | Mary P Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205148624 PECOS PAC ID: 2466629357 Enrollment ID: I20120117000691 |
| Provider Name | Andrew B Cook |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992074116 PECOS PAC ID: 9739349440 Enrollment ID: I20120404000213 |
| Provider Name | Emra M Hopkins |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1588936413 PECOS PAC ID: 9638330897 Enrollment ID: I20120416000021 |
| Provider Name | Tarun Narang |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1205904448 PECOS PAC ID: 9133137359 Enrollment ID: I20130829000169 |
| Provider Name | Nathan Allen Blake |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1548681828 PECOS PAC ID: 1254563414 Enrollment ID: I20140422002303 |
| Provider Name | Ryan C Turk |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063759751 PECOS PAC ID: 4880849090 Enrollment ID: I20140523001314 |
| Provider Name | Dustin M Souther |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1144641788 PECOS PAC ID: 5597980524 Enrollment ID: I20140708001645 |
| Provider Name | Amy W Lee |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1508221763 PECOS PAC ID: 3072810456 Enrollment ID: I20160330001058 |
| Provider Name | Justin L Fletcher |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1023474756 PECOS PAC ID: 5597055723 Enrollment ID: I20160531002480 |
| Provider Name | Marcie W Le |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1194182170 PECOS PAC ID: 6002109790 Enrollment ID: I20160718001650 |
| Provider Name | Daphne Dihuei Yu |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1417314022 PECOS PAC ID: 6305144015 Enrollment ID: I20171003004736 |
| Provider Name | Phillip A Fink |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1124087432 PECOS PAC ID: 5597664730 Enrollment ID: I20180117000690 |
| Provider Name | Gaurav Chand |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346655586 PECOS PAC ID: 7416248885 Enrollment ID: I20180219001625 |
| Provider Name | Olanrewaju Yusuf Jimoh |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1053671586 PECOS PAC ID: 2163738626 Enrollment ID: I20180702000607 |
| Provider Name | Amber Lynn Busiek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255861266 PECOS PAC ID: 4183995467 Enrollment ID: I20181018002981 |
| Provider Name | Colby Hollis |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1700366499 PECOS PAC ID: 6002158086 Enrollment ID: I20190423000380 |
| Provider Name | John King |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609839836 PECOS PAC ID: 8820985856 Enrollment ID: I20190507001066 |
| Provider Name | Heather M. Gschnell |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346505815 PECOS PAC ID: 8820247554 Enrollment ID: I20191205001839 |
| Provider Name | Adam Norman Beam |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1316585417 PECOS PAC ID: 9739514423 Enrollment ID: I20200128001000 |
| Provider Name | Caroline A. Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1245870724 PECOS PAC ID: 6204263783 Enrollment ID: I20200221001892 |
| Provider Name | Victoria Maldonado Rothwell |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316365067 PECOS PAC ID: 7719108042 Enrollment ID: I20200508000043 |
| Provider Name | Kristin A Kapeles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205504891 PECOS PAC ID: 3678962180 Enrollment ID: I20211122001689 |
| Provider Name | Sagar Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710349873 PECOS PAC ID: 7719272137 Enrollment ID: I20220316002530 |
| Provider Name | Christina Frances Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114680311 PECOS PAC ID: 8527448083 Enrollment ID: I20220630002290 |
| Provider Name | Garrett S Greenan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225579584 PECOS PAC ID: 7911325931 Enrollment ID: I20230901003342 |
Novant Health Infectious Disease Specialists Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1900 Randolph Rd, Suite 216, Charlotte, NC 28207 Phone: 704-384-5416 Fax: 704-384-5996 | |
Atrium Health Infectious Disease Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10660 Park Rd, Ste 4400, Charlotte, NC 28210 Phone: 704-355-0607 | |
Amity Medical Group, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6010 E W T Harris Blvd, Charlotte, NC 28215 Phone: 704-208-4134 Fax: 704-248-8068 | |
Companion Health, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5029 Lady Fern Cir, Charlotte, NC 28211 Phone: 704-236-2658 | |
Novant Health Carolina Family Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7110 Lawyers Rd, Charlotte, NC 28227 Phone: 704-537-0020 Fax: 704-316-8634 | |
Kent Seitz Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1421 Orchard Lake Drive, Suite C, Charlotte, NC 28270 Phone: 704-844-0181 Fax: 904-701-6279 | |
Health And Wellness Services Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 715 E 5th St, Suite 214, Charlotte, NC 28202 Phone: 704-909-7954 |