NPIMap

Individual provider Active NPI

Lana Michelle Oliver Haynes, PAC

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1073627956
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001000360 Issued in NC
Practice address
1717 Shipyard Blvd Ste 100
Wilmington, NC 28403-8019
Phone
(910) 794-5355
Fax
(910) 794-5358
NPI assigned
Aug 18, 2006
Last updated
Aug 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001000360 NC Primary

Addresses

Primary practice location

1717 Shipyard Blvd Ste 100
Wilmington, NC 28403-8019

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 948-0291

Other names 1

  • Lana Michelle Oliver Former name

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
I20060503000201 NC Practitioner - Physician Assistant 5597775700 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Plastic Surgery and Dermatology, PLLCGroup PAC ID 1153723531, 11 clinicians
Summit Cosmetic Surgery Center,PAGroup PAC ID 7911973987, 11 clinicians

Practice addresses (Care Compare)

1717 Shipyard Blvd
Suite 100
Wilmington, NC 28403-8019
Phone (910) 794-5355

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
83.12
Promoting interoperability
100
Improvement activities
40
Cost
79.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001000360NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Cosmetic Surgery Center Current Accepting new patients

Locations

1717 Shipyard Blvd
Ste 100
Wilmington, NC 28403
Phone (910) 794-5355

Organizations & group practices 3

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 5

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1073627956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-948-0291",
            "fax_number": "561-859-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 SHIPYARD BLVD STE 100",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284038019",
            "telephone_number": "910-794-5355",
            "fax_number": "910-794-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "LANA",
        "middle_name": "MICHELLE OLIVER",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001000360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LANA",
            "last_name": "OLIVER",
            "middle_name": "MICHELLE",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.