NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Family Care Center - Mooresville

  • Family Medicine Physician
  • Mooresville, NC
National Provider Identifier
1235711334
Registry record updated Jun 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Family Care Center - Mooresville
Practice address
653 Bluefield Road
Suite F
Mooresville, NC 28117
Phone
(704) 883-3378
Fax
(704) 883-3228
NPI assigned
Apr 27, 2021
Last updated
Jun 4, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2021

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

Authorized official

Name
Carla D Johnson
Title
Director of Operations
Phone
(704) 873-5661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

653 Bluefield Road
Suite F
Mooresville, NC 28117

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 936-1364

Other names 1

  • Family Care Center - Mooresville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2228794Family Care Center of Mooresville653 Bluefield Road Suite F, Mooresville, NC 28117Certificate of waiverJun 30, 2027

National Provider Directory

National Provider Directory
Part of
Lakeview OBGYN

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622764800000",
    "number": "1235711334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896199",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896199",
            "telephone_number": "833-936-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 BLUEFIELD ROAD",
            "address_2": "SUITE F",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-883-3378",
            "fax_number": "704-883-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-06-04",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "704-873-5661"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Center - Mooresville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Center - Mooresville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.