Kevin C Addison, MD
Individual provider Active NPI Neonatal-Perinatal Medicine Physician · Mooresville, NC
NPI 1295750651 · NPPES record last updated Aug 31, 2021
Key facts
- NPI
- 1295750651
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neonatal-Perinatal Medicine Physician 2080N0001X
- License
- 2006-00447 (NC)
- Practice address
- 171 Fairview Rd
Mooresville, NC 28117-9500 - Phone
- (704) 660-4390
- Fax
- (704) 660-4399
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100512000066 | NC | Practitioner - Pediatric Medicine | 1557361490 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006-00447 | NC | MD | Neonatal-Perinatal Medicine Physician |
| 0101272440 | VA | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mooresville Hma Physician Management, Inc. | Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 0101272440 | VA | |
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 2006-00447 | NC | Yes |
Addresses
Primary practice location
171 Fairview Rd
Mooresville, NC 28117-9500
Mailing address
171 Fairview Rd
Mooresville, NC 28117-9500
Phone (704) 660-4390
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5904803 | Medicaid | NC |
Other providers in Mooresville, NC
- Brooke Adams
- Hunter Nikkole Adams
- Todd Jerry Adams
- Adaptive Pediatrics Opco LLC
- Arthur Lee Adcock II
- Moriah Addison
- Ruth Damilola Adepetun
- Joe K Ades
- Adm Physical Therapy, LLC
- Advanced Athletic Training Solutions
All providers in Mooresville, NC · Neonatal-Perinatal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.