1. Home
  2. Directory
  3. North Carolina
  4. Charlotte
  5. Clinic Center
  6. NPI Profile

AMITY MEDICAL GROUP, INC.
NPI 1003301300
Clinic/Center - Federally Qualified Health Center (FQHC) in Charlotte, NC

Active since June 28, 2018CLIA Certified · 6 labs
6010 E W T HARRIS BLVD, CHARLOTTE, NC 28215(704) 208-4134(704) 248-8068 Get Directions Write a Review

NPPES record last updated: July 31, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 31, 2024, Apr 30, 2024, Dec 12, 2023 and 1 more (4 updates tracked since 2018).

About Amity Medical Group, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMITY MEDICAL GROUP, INC. (NPI 1003301300) is a healthcare organization registered as a federally qualified health center (fqhc) in Charlotte, North Carolina and active in the NPI registry since June 2018. The organization holds 6 active CLIA laboratory certificates, maintains 5 additional practice locations, and lists Dequeena Smith, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1003301300
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameAMITY MEDICAL GROUP, INC.
Location Address6010 E W T HARRIS BLVDCharlotte, NC 28215-4084
Mailing Address6010 E W T Harris BlvdCharlotte, NC 28215-4084 · (704) 208-4134 · Fax (704) 248-8068
Phone(704) 208-4134
Fax(704) 248-8068
Organization SubpartNo
Authorized OfficialDequeena SmithCredentialing · (704) 493-5326
Enumeration DateJune 28, 2018
Last NPPES UpdateJuly 31, 20244 updates tracked since enumeration
NPPES CertifiedJuly 31, 2024
✔ NPI 1003301300 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedFamily MedicineTaxonomy 207Q00000X
6010 E W T HARRIS BLVD, Charlotte, NC 28215
Open in Google Maps ↗

Secondary Practice Locations 5

Location 110508 Park Rd Ste 130Charlotte, NC 28210-8526 · Phone (704) 208-4134
Location 29835 Monroe Rd # BCharlotte, NC 28270-1471 · Phone (704) 208-4134 · Fax (704) 246-8068
Location 3824 Lower Dallas HwyDallas, NC 28034-9368 · Phone (704) 208-4134 · Fax (704) 246-8068
Location 47945 N Tryon St Ste 112Charlotte, NC 28262-3587 · Phone (704) 764-1387
Location 52300 Randolph Rd Ste ACharlotte, NC 28207-1586 · Phone (704) 764-1387

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amity Medical Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

14

Medicare enrollment records show 14 clinicians reassign Medicare billing to Amity Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 2 practice at this address and 6 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Nurse Practitioner7
Internal Medicine3
Family Practice2
Mental Health Counselor2

Clinicians, nearest first (14)

Sheldine Edwards, NP
Nurse Practitioner
NPI 1952603441
6010 E W T HARRIS BLVD
Charlotte, NC 28215
(914) 682-6540
✔ PECOSSame address
Isabel Rivero
Nurse Practitioner
NPI 1245049345
6010 E W T HARRIS BLVD
Charlotte, NC 28215
(704) 208-4134
✔ PECOSSame address
Jerry Saunders, MD
Internal Medicine
NPI 1306137526
3607 BEATTIES FORD RD
Charlotte, NC 28216
(704) 394-8968
✔ PECOS✔ Accepts Medicare4.1 mi
Karlton Pettis, MD
Internal Medicine
NPI 1871555375
700 S TORRENCE ST STE 100
Charlotte, NC 28204
(704) 372-9393
✔ PECOS9.2 mi
Heather Manos, M.D.
Family Practice
NPI 1427186022
6010 E WT HARRIS BLVD
Charlotte, NC 28215
(704) 208-4134
✔ PECOS9.6 mi
Clarence Ellis, MD
Internal Medicine
NPI 1376505305
1100 BLYTHE BLVD
Charlotte, NC 28203
(704) 355-9047
✔ PECOS9.6 mi
Jason Hardin, MSN, APRN, AGNP-C
Nurse Practitioner
NPI 1932675758
6010 E W T HARRIS BLVD
Charlotte, NC 28215
(704) 208-4134
✔ PECOS12 mi
John Mohan, LCMHCA, LCAS-A
Mental Health Counselor
NPI 1316749922
9835 MONROE RD STE B
Charlotte, NC 28270
(704) 322-4065
✔ PECOS15 mi
Samuel Shores, FNP-BC
Nurse Practitioner
NPI 1992477020
630 MATTHEWS TOWNSHIP PKWY
Matthews, NC 28105
(704) 495-6020
✔ PECOS16 mi
Michelle Clanton, LCAS-A, MAC, B.B.A
Mental Health Counselor
NPI 1295403368
10508 PARK RD STE 130
Charlotte, NC 28210
(704) 874-0200
✔ PECOS17 mi
Sarah Helms, FNP-C
Nurse Practitioner
NPI 1083964290
824 LOWER DALLAS HWY
Dallas, NC 28034
(704) 874-0200
✔ PECOS18 mi
Ashley Prince, DNP
Nurse Practitioner
NPI 1740938646
545 LUCKY WAY
Dallas, NC 28034
(704) 524-1522
✔ PECOS21 mi
Richard Wynn, M.D.
Family Practice
NPI 1356365480
16147 LANCASTER HWY SUITE 140
Charlotte, NC 28277
(704) 208-4134
✔ PECOS22 mi
Karen Puett, FNP
Nurse Practitioner
NPI 1205081460
1504 2ND ST NE
Hickory, NC 28601
(828) 322-3037
✔ PECOS✔ Accepts Medicare40 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 6

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2078502

Amity Medical Group, Inc · Charlotte, NC
Active · expires May 29, 2028
CLIA Number34D2078502
Laboratory TypePhysician Office
Certificate Effective DateMay 30, 2026
Certificate Expiration DateMay 29, 2028
Laboratory DirectorRichard Wynn
Laboratory Phone(704) 208-4134
Laboratory LocationAmity Medical Group, Inc6010 East W T Harris Blvd, Charlotte, NC 28215
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2133422

Amity Medical Group, Inc · Charlotte, NC
Active · expires Jul 11, 2027
CLIA Number34D2133422
Laboratory TypePhysician Office
Certificate Effective DateJuly 12, 2025
Certificate Expiration DateJuly 11, 2027
Laboratory DirectorRichard Wynn
Laboratory Phone(704) 208-4134
Laboratory LocationAmity Medical Group, Inc6010 East W T Harris Boulevard, Charlotte, NC 28215
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D1037371

Amity Medical Group · Dallas, NC
Active · expires Jun 30, 2028
CLIA Number34D1037371
Laboratory TypePhysician Office
Certificate Effective DateJuly 1, 2026
Certificate Expiration DateJune 30, 2028
Laboratory DirectorRichard J. Wynn
Laboratory Phone(704) 874-0201
Laboratory LocationAmity Medical Group824 Lower Dallas Highway, Dallas, NC 28034
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D1075060

Amity Medical Group · Charlotte, NC
Active · expires Oct 11, 2027
CLIA Number34D1075060
Laboratory TypePhysician Office
Certificate Effective DateOctober 12, 2025
Certificate Expiration DateOctober 11, 2027
Laboratory DirectorKarlton S. Pettis MD
Laboratory Phone(704) 503-6336
Laboratory LocationAmity Medical Group7945 North Tryon St, Ste 112, Charlotte, NC 28262
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2060451

Amity Medical Group · Charlotte, NC
Active · expires Jun 17, 2027
CLIA Number34D2060451
Laboratory TypePhysician Office
Certificate Effective DateJune 18, 2025
Certificate Expiration DateJune 17, 2027
Laboratory DirectorClarence O. Ellis
Laboratory Phone(704) 372-9393
Laboratory LocationAmity Medical Group2300 Randolph Rd, Unit A, Charlotte, NC 28207
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2229010

Amity Medical Group, Inc · Charlotte, NC
Active · expires Jul 5, 2027
CLIA Number34D2229010
Laboratory TypePhysician Office
Certificate Effective DateJuly 6, 2025
Certificate Expiration DateJuly 5, 2027
Laboratory DirectorRichard T. Wynn
Laboratory Phone(704) 208-4134
Laboratory LocationAmity Medical Group, Inc9835 Monroe Rd Suite B, Charlotte, NC 28270
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amity Medical Group, Inc.'s NPI number?

The NPI number for Amity Medical Group, Inc. is 1003301300. It was assigned to this organization in the NPPES registry on June 28, 2018.

Where is Amity Medical Group, Inc. located?

Amity Medical Group, Inc. is located at 6010 E W T Harris Blvd, Charlotte, NC 28215. The listed phone number is (704) 208-4134.

What is Amity Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Amity Medical Group, Inc. enrolled in Medicare?

Yes. Amity Medical Group, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Amity Medical Group, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 14 clinicians in 4 Medicare specialties reassign their Medicare billing to Amity Medical Group, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (7), Internal Medicine (3) and Family Practice (2). Of these, 2 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Amity Medical Group, Inc. hold CLIA laboratory certificates?

Yes. 6 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Amity Medical Group, Inc. accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and Blue Cross and Blue Shield of NC and 2 other insurers list Amity Medical Group, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Amity Medical Group, Inc. was last updated on July 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.