Individual provider Active NPI

Cynthia Loree Mitchell, P.A.-C

  • Physician Assistant
  • Statesville, NC
National Provider Identifier
1073677720
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05394 Issued in NC
Practice address
700 Sullivan Rd
Statesville, NC 28677-3440
Phone
(704) 924-9111
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1501146 KS
Physician Assistant 363A00000X 23011075 NY
Physician Assistant 363A00000X 0010-05394 NC Primary

Addresses

Primary practice location

700 Sullivan Rd
Statesville, NC 28677-3440

Mailing address

PO Box 1845
Statesville, NC 28687-1845
Phone (704) 873-4277

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150428002340 NC Practitioner - Physician Assistant 8820099898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

129 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8245

138 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 873-1021

142 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8256

152 Sherlock Dr
Statesville, NC 28625-1916
Phone (704) 838-8210

208 Old Mocksville Rd
Statesville, NC 28625-1930
Phone (704) 878-2011

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1501146KSMDPhysician Assistant
0010-05394NCMDPhysician Assistant
23011075NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, PA CurrentSince Aug 6, 2018 Accepting new patients
Piedmont Healthcare, P.a. CurrentSince Aug 6, 2018 Accepting new patients
The Covenant Group PA Past Accepting new patients

Locations

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

700 Sullivan Rd
Statesville, NC 28677
Phone (704) 924-9111

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1073677720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845",
            "telephone_number": "704-873-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SULLIVAN RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773440",
            "telephone_number": "704-924-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "CYNTHIA",
        "middle_name": "LOREE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1501146",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23011075",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.