NPIMap

Organization Active NPI

Wellcomemd NC Clinic PLLC

  • Internal Medicine Physician
  • Mooresville, NC
National Provider Identifier
1013525278
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLCOMEMD NC CLINIC PLLC
Practice address
111 Kilson Dr Ste 201
Mooresville, NC 28117-8218
Phone
(704) 444-0999
Fax
(980) 498-7007
NPI assigned
Jul 14, 2020
Last updated
Jul 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Jessica Parnell
Title
Regional Director of Practice Manag
Phone
(804) 256-8205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

111 Kilson Dr Ste 201
Mooresville, NC 28117-8218

Mailing address

2500 Gaskins Rd Ste a
Richmond, VA 23238-1480
Phone (704) 444-0999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200901000339 NC Part B Supplier - Clinic/Group Practice 0648697078 Receives reassigned benefits from 2 practitioners
Practice locations: Charlotte, NC; Mooresville, NC

National Provider Directory

National Provider Directory

Locations

150 Fairview Rd
Ste 325
Mooresville, NC 28117
Phone (704) 444-0999

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1013525278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 GASKINS RD STE A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232381480",
            "telephone_number": "704-444-0999",
            "fax_number": "980-498-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 KILSON DR STE 201",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178218",
            "telephone_number": "704-444-0999",
            "fax_number": "980-498-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCOMEMD NC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "PARNELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR OF PRACTICE MANAG",
        "authorized_official_telephone_number": "804-256-8205"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.