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QUEENS UNIVERSITY OF CHARLOTTE
NPI 1457986515
Family Medicine - Sports Medicine in Charlotte, NC

Active since March 10, 2020CLIA 34D0869311 · Waiver
1900 SELWYN AVE, CHARLOTTE, NC 28274(972) 367-4845 Get Directions Write a Review

NPPES record last updated: March 10, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Queens University Of Charlotte NPPES

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

QUEENS UNIVERSITY OF CHARLOTTE (NPI 1457986515), doing business as Queens Sports Medicine, is a healthcare organization registered as a sports medicine in Charlotte, North Carolina and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Mouzon Bass, Administrator/agent, as its authorized official.

NPPES Registry Identity

NPI1457986515
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameQUEENS UNIVERSITY OF CHARLOTTE
Location Address1900 SELWYN AVECharlotte, NC 28274-0001
Mailing Address5050 Spring Valley RdDallas, TX 75244-3995
Phone(972) 367-4845
Organization SubpartNo
Authorized OfficialMouzon BassAdministrator/agent · (972) 367-4845
Enumeration DateMarch 10, 2020
NPPES CertifiedMarch 10, 2020
✔ NPI 1457986515 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
1900 SELWYN AVE, Charlotte, NC 28274
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Other Names 1

Doing Business AsQueens Sports Medicine

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 34D0869311

Queens University Of Charlotte · Charlotte, NC
Active · expires Aug 31, 2026
CLIA Number34D0869311
Laboratory TypeSchool/Student Health Service
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorJill O. Perry
Laboratory Phone(704) 337-2220
Laboratory LocationQueens University Of CharlotteHealth And Wellness Center 2322 Wellesley Avenue, Charlotte, NC 28274
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEG JOHNSON MT-BC
Music Therapist
1900 SELWYN AVE, QUEENS UNIVERSITY OF CHARLOTTE
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2520
REBECCA HOPE RICH ATC
Specialist/Technologist (Athletic Trainer)
1900 SELWYN AVE, #421
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2405
MR. WILLIE PHILLIPS II ATC
Physical Medicine & Rehabilitation (Sports Medicine)
1900 SELWYN AVE
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2405
MICHAEL HABER ATC
Community Health Worker
1900 SELWYN AVE
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2405
HOLLEY CHRISTINE MOSHER M.ED, LCMHCA, NCC
Counselor (Mental Health)
1900 SELWYN AVE
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2556
DR. VARVARA PASIALI PHD, MT-BC
Music Therapist
1900 SELWYN AVE
CHARLOTTE, NC 28274
Mecklenburg County (704) 688-2720
RACHEL LEA TAYLOR LAT, ATC
Specialist/Technologist (Athletic Trainer)
1900 SELWYN AVE
CHARLOTTE, NC 28274
Mecklenburg County (704) 337-2405

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 Queens University Of Charlotte's NPI number?

The NPI number for Queens University Of Charlotte is 1457986515. It was assigned to this organization in the NPPES registry on March 10, 2020. The provider is doing business as Queens Sports Medicine.

Where is Queens University Of Charlotte located?

Queens University Of Charlotte is located at 1900 Selwyn Ave, Charlotte, NC 28274. The listed phone number is (972) 367-4845.

What is Queens University Of Charlotte's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Does Queens University Of Charlotte hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0869311) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Queens University Of Charlotte was last updated on March 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.