Individual provider Active NPI

Logan Glenn Lovell, PA

  • Physician Assistant
  • Jacksonville, NC
National Provider Identifier
1144013657
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
317 Western Blvd
Jacksonville, NC 28546-6338
Phone
(910) 577-2345
NPI assigned
May 27, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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 Primary

Addresses

Primary practice location

317 Western Blvd
Jacksonville, NC 28546-6338

Mailing address

10605 Kettering Dr Apt 1013
Charlotte, NC 28226-4776
Phone (843) 504-4166

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
I20260112000748 NC Practitioner - Physician Assistant 5597241349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group North CarolinaGroup PAC ID 7719162254, 78 clinicians

Practice addresses (Care Compare)

317 Western Blvd
Jacksonville, NC 28546-6338
Phone (910) 577-2345

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group North Carolina CurrentSince Nov 26, 2025 Accepting new patients

Locations

317 Western Blvd
Jacksonville, NC 28546
Phone (910) 577-2240

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

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 1

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": "1748304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1144013657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10605 KETTERING DR APT 1013",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282264776",
            "telephone_number": "843-504-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466338",
            "telephone_number": "910-577-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVELL",
        "first_name": "LOGAN",
        "middle_name": "GLENN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-27",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.