Individual provider Active NPI

James Bryan Lake, FNP-C

  • Primary Care Nurse Practitioner
  • Kinston, NC
National Provider Identifier
1124704796
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
LAKE-2S9JB Issued in NC
Practice address
701 Doctors Dr Ste N
Kinston, NC 28501-1584
Phone
(252) 559-2200
Fax
(252) 523-7642
NPI assigned
Jun 27, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LAKE-2S9JB NC
Primary Care Nurse Practitioner 363LP2300X LAKE-2S9JB NC Primary

Addresses

Primary practice location

701 Doctors Dr Ste N
Kinston, NC 28501-1584

Mailing address

1016 Sedbrook LN
Winterville, NC 28590-6008
Phone (252) 916-4443

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
I20230918003865 NC Practitioner - Nurse Practitioner 9032573472 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
Telehealth
Offers telehealth services
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

701 Doctors Dr
Suite N
Kinston, NC 28501-1584
Phone (252) 559-2200

Hospital & facility affiliations

  • Unc Lenoir Health Care Hospital, Kinston, NC, CCN 340027

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LAKE-2S9JBNCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Sep 5, 2023 Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

701 Doctors Dr
Ste N
Kinston, NC 28501
Phone (252) 559-2200

Organizations & group practices 1

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.

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": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1124704796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 SEDBROOK LN",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285906008",
            "telephone_number": "252-916-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DOCTORS DR STE N",
            "city": "KINSTON",
            "state": "NC",
            "postal_code": "285011584",
            "telephone_number": "252-559-2200",
            "fax_number": "252-523-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JAMES",
        "middle_name": "BRYAN",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "LAKE-2S9JB",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "LAKE-2S9JB",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kinston, NC

Sources for this page

Verify at the official NPI Registry.