NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Family Care Center of Mocksville

  • Family Medicine Physician
  • Mocksville, NC
National Provider Identifier
1063584134
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Family Care Center of Mocksville
Practice address
101 Wilkesboro St Ste B
Mocksville, NC 27028-2321
Phone
(336) 753-0800
Fax
(336) 753-0805
NPI assigned
Nov 14, 2006
Last updated
Apr 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Ms. Vickie Morf
Title
Revenue Cycle Manager
Phone
(704) 878-4542

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

101 Wilkesboro St Ste B
Mocksville, NC 27028-2321

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 936-1364

Other identifiers 1

IdentifierTypeStateIssuer
5911525MedicaidNC

Other names 1

  • Family Care Center of Mocksville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Imh Prof Infect Disease11 organizations share this tax ID, including this one
Part of
Lakeview OBGYN

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

310 Davie Ave
Statesville, NC 28677
Phone (704) 873-3269

510 N Main St
Troutman, NC 28166
Phone (704) 528-3721

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1063584134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896199",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896199",
            "telephone_number": "833-936-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WILKESBORO ST STE B",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282321",
            "telephone_number": "336-753-0800",
            "fax_number": "336-753-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2006-11-14",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "MORF",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "704-878-4542",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911525",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Center of Mocksville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Center of Mocksville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mocksville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.