John Hudson Fillmore, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

200786 Issued in NC

Practice address

640 Whiteville Rd NW
Shallotte, NC 28470-6503

Phone

(910) 754-4441

NPI assigned

Feb 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Novant Health Employer Solutions, LLC

  • Occupational Medicine Physician
  • Charlotte, NC
  • NPI 1407668700
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1306950282
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1891764320
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  • Surgery Physician
  • Winston Salem, NC
  • NPI 1114250354
  NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Shallotte, NC
  • NPI 1710051123
  NPD
• Novant Medical Group, Inc.

  • Cardiovascular Disease Physician
  • Southport, NC
  • NPI 1679528384
  NPD
• Novant Health Medical Group, LLC

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1134841802
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1003889080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "910-754-4441",
            "fax_number": "910-754-5307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 WHITEVILLE RD NW",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284706503",
            "telephone_number": "910-754-4441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5145 Sellers Rd",
            "address_purpose": "LOCATION",
            "city": "Shallotte",
            "state": "NC",
            "postal_code": "284703405",
            "country_code": "US",
            "telephone_number": "910-754-4441",
            "fax_number": "910-754-5307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "JOHN",
        "middle_name": "HUDSON",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "200786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005644",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0131P",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00188452",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "2592037",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348906A",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JFILLMORE16758@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "640 Whiteville Rd NW",
            "city": "Shallotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284706503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Julie Ann Evans, PHARMD
• Family First Chiropractic Inc
• Family Medical Supply LLC
• Faith Farris, PA
• Caitlin Lane Faulk, LCMHC, LCAS
• Rachel Marie Findley, FNP-BC
• Allyn Fischer, OTR/L
• Peter Lawrence Fischer, MD
• Lynda Keeter Fletcher, PT
• Stephanie Flowers

• Nurse Practitioner in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.