NPIMap

Individual provider Active NPI

Craig Daniel Dubois, M.D.

  • Neurology Physician
  • Mooresville, NC
National Provider Identifier
1164414819
Registry record updated Jul 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
9400239 Issued in NC
Practice address
124 Professional Park Dr
Suite a
Mooresville, NC 28117-5537
Phone
(704) 662-3077
Fax
(704) 662-3458
NPI assigned
Aug 18, 2005
Last updated
Jul 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 9400239 NC Primary

Addresses

Primary practice location

124 Professional Park Dr
Suite a
Mooresville, NC 28117-5537

Mailing address

124 Professional Park Dr
Suite a
Mooresville, NC 28117-5537
Phone (704) 662-3077

Other identifiers 1

IdentifierTypeStateIssuer
89013KPMedicaidNC

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
I20100804000925 NC Practitioner - Neurology 8527132836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Ohio State University College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

124 Professional Park Dr a
Mooresville, NC 28117-5610
Phone (704) 662-3077

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Norman Neurology Neurology Current Accepting new patients
Lake Norman Neurology PA Neurology CurrentSince Jul 5, 1994 Accepting new patients
Piedmont Healthcare, PA CurrentSince Aug 6, 2012 Accepting new patients
Piedmont Healthcare, P.a. Neurology CurrentSince Aug 6, 2012 Accepting new patients
Trinity Health Care PA PastSince Feb 1, 1999 Accepting new patients

Locations

124 Professional Park Dr
Ste A
Mooresville, NC 28117
Phone (704) 622-3077

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

340 Signal Hill Dr
Ste A
Statesville, NC 28625
Phone (704) 873-6065

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

Interoperability endpoints

  • Direct secure messaging: craigdubois@phc.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1164414819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-662-3077",
            "fax_number": "704-662-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-662-3077",
            "fax_number": "704-662-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOIS",
        "first_name": "CRAIG",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "9400239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013KP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.