Individual provider Active NPI

Kevin Matthew O'Connor, PA-C

  • Physician Assistant
  • Leland, NC
National Provider Identifier
1225407539
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06001 Issued in NC
Practice address
509 Olde Waterford Way
Leland, NC 28451-4125
Phone
(704) 293-8836
NPI assigned
Sep 16, 2015
Last updated
Nov 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 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 0010-06001 NC Primary

Addresses

Primary practice location

509 Olde Waterford Way
Leland, NC 28451-4125

Mailing address

509 Olde Waterford Way
Leland, NC 28451-4125
Phone (704) 293-8836

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
I20251121004083 NC Practitioner - Physician Assistant 7214270511 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4441

7910 US Hwy 117 S
Rocky Point, NC 28457-9431
Phone (910) 300-4500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-06001NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Nov 1, 2025 Accepting new patients
NMG Health Services LLC CurrentSince Nov 1, 2025 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2025 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

501 Olde Waterford Way
Leland, NC 28451
Phone (910) 383-1098

7910 US Hwy 117 S
Rocky Point, NC 28457
Phone (910) 300-4320

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: koconnor1754176@direct.novanthealth.org

Organizations & group practices 9

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 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": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1225407539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514125",
            "telephone_number": "704-293-8836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514125",
            "telephone_number": "704-293-8836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "KEVIN",
        "middle_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-16",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leland, NC

Sources for this page

Verify at the official NPI Registry.