Southern Mobile Medical Group PA
NPI 1730903675ActiveOrganization· General Practice· Charlotte, NC
General Practice in Charlotte, North Carolina, registered in NPPES in November 2024. The authorized official on file is Zachary Mandler, Director Of Contracting. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1730903675 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 7, 2024 |
| Last updated in NPPES | Feb 24, 2026 |
| Certified by provider | Feb 24, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NC); Part B Supplier - Clinic/Group Practice (SC) |
|---|
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