Lillykutty Abraham Modoor, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5004280 Issued in NC

Practice address

650 Highland Ave Ste 100
Winston Salem, NC 27101-4304

Phone

(336) 607-8523

Fax

(336) 773-0916

NPI assigned

Jan 30, 2009

Last updated

Feb 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Daymark Recovery Services IncGroup PAC ID 0547233975, 132 clinicians

Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• High Point Regional Health System Hospital, High Point, NC, CCN 340004

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: integratedcare@direct.daymarkrecovery.nextgenshare.com
• Direct secure messaging: lillykutty.modoor.p1@direct.daymarkrecovery.nextgenshare.com
• Direct secure messaging: lmodoor2753306@carolinashealthcaresystem.direct-ci.com

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

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243
  Medicare reassignment Care Compare group NPD
• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment Care Compare group NPD
• Wake Forest University Health Sciences

  • Clinic/Center
  • Statesville, NC
  • NPI 1245757665
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• High Point Regional Health

  dba High Point Regional

  • General Acute Care Hospital
  • High Point, NC
  • NPI 1396746228
  Care Compare affiliation

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1013155969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HIGHLAND AVE STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014304",
            "telephone_number": "336-607-8523",
            "fax_number": "336-773-0916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Highland Ave Unit 116",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271014181",
            "country_code": "US",
            "telephone_number": "336-703-3250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODOOR",
        "first_name": "LILLYKUTTY",
        "middle_name": "ABRAHAM",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5004280",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004280",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5004280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "integratedcare@direct.daymarkrecovery.nextgenshare.com",
            "affiliation": "Y",
            "affiliationName": "Daymark Recovery Services Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "284 Executive Park Dr",
            "address_2": "Suite 100",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280251831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Moda Human Services L.L.C
• John Modarress, MD
• Modern Hope of North Carolina
• Mona Modi
• David M Modlin, MSW, LCSW
• Samuel Moedjianto, MD
• Carolyn Moench, PA
• Marissa Moffitt
• Ali Mofidi, MD
• Nequesha Shane Mohamed, MD

• Psychiatric/Mental Health Nurse Practitioner in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.