NPIMap

Individual provider Active NPI

Nancy Susan Desillier, RN

  • Nurse Practitioner
  • Bolivia, NC
National Provider Identifier
1104524271
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5019582 Issued in NC
Practice address
257 Hospital Dr NE Ste 100
Bolivia, NC 28422-8411
Phone
(910) 721-4150
Fax
(910) 721-4159
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 351739 NC
Nurse Practitioner 363L00000X 5019582 NC Primary

Addresses

Primary practice location

257 Hospital Dr NE Ste 100
Bolivia, NC 28422-8411

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

240 Hospital Dr NE
Bolivia, NC 28422-8346
Phone (910) 721-1000

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
I20240423003473 NC Practitioner - Nurse Practitioner 1153760194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

584 Hospital Nedr C
Bolivia, NC 28422
Phone (910) 721-4100

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141
  • Novant Health Brunswick Medical Center Hospital, Supply, NC, CCN 340158

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
351739NCMDRegistered Nurse
5019582NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Mar 21, 2024 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Mar 21, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

257 Hospital Dr NE
Ste 100
Bolivia, NC 28422
Phone (910) 721-4150

240 Hospital Dr NE
Bolivia, NC 28422
Phone (336) 399-7678

584 Hospital Dr NE
Unit C
Bolivia, NC 28422
Phone (910) 721-4100

75 Emerson Bay Rd
Ste 104
Carolina Shores, NC 28467
Phone (910) 667-4283

1333 S Dickinson Dr
Unit 230
Leland, NC 28451
Phone (910) 254-1033

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

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

Interoperability endpoints

  • Direct secure messaging: ndesillier1100071@direct.novanthealth.org

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 2

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": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1104524271",
    "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": "257 HOSPITAL DR NE STE 100",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228411",
            "telephone_number": "910-721-4150",
            "fax_number": "910-721-4159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 Hospital Dr NE",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284228346",
            "country_code": "US",
            "telephone_number": "910-721-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESILLIER",
        "first_name": "NANCY",
        "middle_name": "SUSAN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "351739",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5019582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivia, NC

Sources for this page

Verify at the official NPI Registry.