NPIMap

Individual provider Active NPI

Lisa Annette Devries, APRN

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1053883223
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5012786 Issued in NC
Practice address
1918 Randolph Rd Ste 350
Charlotte, NC 28207-1111
Phone
(704) 384-1750
Fax
(704) 384-1720
NPI assigned
Dec 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5012786 NC Primary

Addresses

Primary practice location

1918 Randolph Rd Ste 350
Charlotte, NC 28207-1111

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

9229 Hollow Bend Dr
Huntersville, NC 28078-5095
Phone (863) 660-5006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220113001376 NC Practitioner - Nurse Practitioner 2860884301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

1918 Randolph Rd
Suite 350
Charlotte, NC 28207-1111
Phone (704) 384-1750

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Presbyterian Hospital CurrentSince Nov 20, 2021 Accepting new patients
The Presbyterian Hospital CurrentSince Nov 20, 2021 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 1, 2023 Accepting new patients
The Presbyterian Hospital Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 1, 2023 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

1918 Randolph Rd
Ste 350
Charlotte, NC 28207
Phone (704) 384-1750

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: ldevries1010385@direct.novanthealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1545868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1053883223",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD STE 350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071111",
            "telephone_number": "704-384-1750",
            "fax_number": "704-384-1720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9229 Hollow Bend Dr",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280785095",
            "country_code": "US",
            "telephone_number": "863-660-5006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVRIES",
        "first_name": "LISA",
        "middle_name": "ANNETTE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-27",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.