Individual provider Active NPI

Cody Elizabeth Homistek, D.O.

  • Family Medicine Physician
  • Mooresville, NC
National Provider Identifier
1306292669
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2018-00103 Issued in NC
Practice address
106 Corporate Park Dr
Suite 200 & 300
Mooresville, NC 28117-7134
Phone
(704) 235-9090
Fax
(704) 235-9101
NPI assigned
May 5, 2016
Last updated
Sep 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2018-00103 NC Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

106 Corporate Park Dr
Suite 200 & 300
Mooresville, NC 28117-7134

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

19485 Old Jetton Rd
Cornelius, NC 28031-6582
Phone (704) 316-5170

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chomistek331666@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
I20190515000792 NC Practitioner - Family Practice 7911288626 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

106 Corporate Park Dr
Mooresville, NC 28117-7134
Phone (704) 887-4530

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018-00103NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Jul 16, 2020 Accepting new patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Jul 16, 2020 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

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

106 Corporate Park Dr
#200300
Mooresville, NC 28117
Phone (704) 235-9090

106 Corporate Park Dr
Ste 200
Mooresville, NC 28117
Phone (704) 235-9090

123 Professional Park Dr
Ste 200
Mooresville, NC 28117
Phone (423) 343-7016

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

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

Organizations & group practices 4

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 7

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": "1462406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1306292669",
    "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": "106 CORPORATE PARK DR",
            "address_2": "SUITE 200 & 300",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177134",
            "telephone_number": "704-235-9090",
            "fax_number": "704-235-9101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19485 Old Jetton Rd",
            "address_purpose": "LOCATION",
            "city": "Cornelius",
            "state": "NC",
            "postal_code": "280316582",
            "country_code": "US",
            "telephone_number": "704-316-5170",
            "fax_number": "704-384-1776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOMISTEK",
        "first_name": "CODY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-05",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2018-00103",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chomistek331666@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "19485 Old Jetton Rd",
            "city": "Cornelius",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280316582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.