Individual provider Active NPI

Stephanie Banaszak Elkins, M.D.

  • Family Medicine Physician
  • Mooresville, NC
National Provider Identifier
1194718403
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200301350 Issued in NC
Practice address
106 Corporate Park Dr
Suite 200 & 300
Mooresville, NC 28117-7134
Phone
(704) 235-9090
Fax
(704) 235-9101
NPI assigned
Aug 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200301350 NC Primary

Addresses

Primary practice location

106 Corporate Park Dr
Suite 200 & 300
Mooresville, NC 28117-7134

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

130 Plantation Ridge Dr
Suite 100
Mooresville, NC 28117-9238
Phone (704) 316-1635

Other practice location 2

130 Plantation Ridge Dr
Suite 100
Mooresville, NC 28117-9238
Phone (704) 316-1635

Other practice location 3

123 Professional Park Dr Ste 200
Mooresville, NC 28117
Phone (423) 343-7016

Other identifiers 1

IdentifierTypeStateIssuer
5901730MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address selkinS5367@direct.novanthealth.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050921001054 NC Practitioner - Family Practice 4082648837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

130 Plantation Ridge Dr
Suite 100
Mooresville, NC 28117-9238
Phone (704) 316-1635

16525 Holly Crest LN
Suite 150
Huntersville, NC 28078-4911
Phone (704) 384-1725

3367 N NC 16 Business Hwy
Denver, NC 28037-8265
Phone (419) 221-6717

6909 Prosperity Church Rd
Huntersville, NC 28078-6698
Phone (704) 384-1425

Hospital & facility affiliations

  • Gentiva Health Services Home health agency, Hickory, NC, CCN 347300
  • Hospice of Iredell County, Inc Hospice, Statesville, NC, CCN 341517
  • Novant Health Huntersville Medical Center Hospital, Huntersville, NC, CCN 340183
  • Duke Health Lake Norman Hospital Hospital, Mooresville, NC, CCN 340129
  • Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200301350NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Medical Group, Inc. CurrentSince Jul 16, 2020 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Organizations & group practices 3

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 9

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1194718403",
    "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": "106 CORPORATE PARK DR",
            "address_2": "SUITE 200 & 300",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177134",
            "telephone_number": "704-235-9090",
            "fax_number": "704-235-9101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Plantation Ridge Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281179238",
            "country_code": "US",
            "telephone_number": "704-316-1635",
            "fax_number": "704-316-1636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Plantation Ridge Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281179238",
            "country_code": "US",
            "telephone_number": "704-316-1635",
            "fax_number": "704-316-1636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 Professional Park Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "28117",
            "country_code": "US",
            "telephone_number": "423-343-7016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELKINS",
        "first_name": "STEPHANIE",
        "middle_name": "BANASZAK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200301350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901730",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "selkinS5367@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "106 Corporate Park Dr",
            "address_2": "Suite 200 & 300",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281177134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.