Individual provider Active NPI

Jennifer M Drake, ANP-BC

  • Nurse Practitioner
  • Mooresville, NC
National Provider Identifier
1104056167
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5004397 Issued in NC
Practice address
131 Welton Way
Mooresville, NC 28117-9163
Phone
(704) 360-4564
Fax
(704) 360-4553
NPI assigned
Jul 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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 5004397 NC Primary

Addresses

Primary practice location

131 Welton Way
Mooresville, NC 28117-9163

Mailing address

249 Williamson Rd
Suite 101
Mooresville, NC 28117-8195
Phone (704) 360-4564

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
I20150519002091 NC Practitioner - Nurse Practitioner 7810217643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolina Pain and Weight Loss, PA 8 clinicians

Practice addresses (Care Compare)

131 Welton Way
Mooresville, NC 28117-9163
Phone (704) 360-4564

Merit-based Incentive Payment System (MIPS)

Final score
96.03 of 100Reported as group
Quality
90
Promoting interoperability
98
Improvement activities
40
Cost
74.09

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Pain and Weight Loss, PA Nurse Practitioner CurrentSince Apr 13, 2015 Accepting new patients
Carolina Pain and Weight Loss Nurse Practitioner CurrentSince Apr 13, 2015 Accepting new patients

Locations

131 Welton Way
Mooresville, NC 28117
Phone (704) 360-4564

249 Williamson Rd
Ste 101
Mooresville, NC 28117
Phone (704) 360-4564

Interoperability endpoints

  • Direct secure messaging: jennifer.drake@cpwl.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/GGICCA/Endpoint/GGICCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/GGICCA

Organizations & group practices 2

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": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1104056167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 WILLIAMSON RD",
            "address_2": "SUITE 101",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178195",
            "telephone_number": "704-360-4564",
            "fax_number": "704-360-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 WELTON WAY",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179163",
            "telephone_number": "704-360-4564",
            "fax_number": "704-360-4553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-23",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5004397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.