Mellisa Sue Conerly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-03560 Issued in NC

Practice address

4309 Emperor Blvd Ste 125
Durham, NC 27703-8068

Phone

(919) 964-3535

NPI assigned

Jun 13, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Mellisa Sue Nowak Former name

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

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Imperial Center Family Medicine and Immediate Care PLLCGroup PAC ID 2668639618, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: mellisa.conerly.1@9649.direct.athenahealth.com

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.

• Imperial Center Family Medicine and Immediate Care PLLC

  • Family Medicine Physician
  • Durham, NC
  • NPI 1881714707
  Medicare reassignment Care Compare group
• Eventus Wholehealth, PLLC

  • Family Medicine Physician
  • Concord, NC
  • NPI 1548759392
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1215197116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 FLATHEAD PL",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275263583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 EMPEROR BLVD STE 125",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277038068",
            "telephone_number": "919-964-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONERLY",
        "first_name": "MELLISA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-13",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELLISA",
            "last_name": "NOWAK",
            "middle_name": "SUE",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Concern of Durham, Inc
• Concertocare Medical Group of North Carolina, PC
• Conducive Solutions, Inc.
• Catherine Mary Cone, MHS, PA-C
• Christina K Cone, NP
• Sianna Congdon, CNM
• Anabel Bouton Conigliaro, PA-C
• David Coniglio, PA-C
• Eric Benson Conklin, MD
• Michael Conley, PH.D.

• Physician Assistant in Durham, NC
• Providers in Durham, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.