Individual provider Active NPI

Michael Christopher Ficenec, MD

  • Pediatrics Physician
  • Huntersville, NC
National Provider Identifier
1295759983
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2005-00379 Issued in NC
Practice address
10305 Hamptons Park Dr Ste 101
Huntersville, NC 28078-7221
Phone
(704) 384-1130
Fax
(704) 384-1131
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2005-00379 NC Primary

Addresses

Primary practice location

10305 Hamptons Park Dr Ste 101
Huntersville, NC 28078-7221

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

9908 Couloak Dr
Suite 103
Charlotte, NC 28216-8678
Phone (704) 801-2025

Other practice location 2

133 Welton Way Ste C
Mooresville, NC 28117
Phone (704) 664-2552

Other practice location 3

133 Welton Way Ste C
Mooresville, NC 28117
Phone (704) 664-2552

Other identifiers 2

IdentifierTypeStateIssuer
5900935MedicaidNC
1295759983MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mficenec536959@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
I20050613001185 NC Practitioner - Pediatric Medicine 3870537681 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005-00379NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group Inc. CurrentSince Jun 30, 2019 Accepting new patients
NH Digital Health Services, LLC CurrentSince Sep 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jun 30, 2019 Accepting new patients
NH Digital Health Services, LLC CurrentSince Sep 7, 2022 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
South Lake Pediatrics Pediatrics Past Accepting new patients

Locations

10305 Hamptons Park Dr
Ste 101
Huntersville, NC 28078
Phone (704) 316-5388

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

2085 Frontis Plaza Blvd
Winston Salem, NC 27103
Phone (336) 277-7226

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

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1295759983",
    "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": "10305 HAMPTONS PARK DR STE 101",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787221",
            "telephone_number": "704-384-1130",
            "fax_number": "704-384-1131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9908 Couloak Dr",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282168678",
            "country_code": "US",
            "telephone_number": "704-801-2025",
            "fax_number": "704-801-2026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "133 Welton Way Ste C",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "28117",
            "country_code": "US",
            "telephone_number": "704-664-2552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "133 Welton Way Ste C",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "28117",
            "country_code": "US",
            "telephone_number": "704-664-2552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FICENEC",
        "first_name": "MICHAEL",
        "middle_name": "CHRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2005-00379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900935",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295759983",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mficenec536959@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "133 Welton Way Ste C",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntersville, NC

Sources for this page

Verify at the official NPI Registry.