NPIMap

Individual provider Active NPI

Jackie Rex Faircloth, MD

  • Family Medicine Physician
  • Cornelius, NC
National Provider Identifier
1306861679
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200100232 Issued in NC
Practice address
20036 Zion Ave
Ste 100
Cornelius, NC 28031-8435
Phone
(704) 801-7400
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200100232 NC Primary

Addresses

Primary practice location

20036 Zion Ave
Ste 100
Cornelius, NC 28031-8435

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

101 E W T Harris Blvd
Ste 5401
Charlotte, NC 28262-3485
Phone (704) 863-9700

Other practice location 2

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277-3372
Phone (704) 667-2650

Other practice location 3

10226 Couloak Dr
Ste 100
Charlotte, NC 28216-7675
Phone (704) 801-7380

Other practice location 4

9611 Sherrill Estates Rd
Ste B
Huntersville, NC 28078-6485
Phone (704) 801-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040830000552 NC Practitioner - Family Practice 8224003629 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Atrium Health North Market Network LLCGroup PAC ID 1557743440, 158 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

20036 Zion Ave
Suite 100
Cornelius, NC 28031-8435
Phone (704) 801-7400

4525 Cameron Valley Pkwy
Suite 4100D
Charlotte, NC 28211-4369
Phone (980) 402-1800

548 White Oaks Dr
Salisbury, NC 28147-8183
Phone (704) 636-0271

7482 Waterside Crossing Blvd
Suite 103
Denver, NC 28037-3006
Phone (704) 827-0598

Hospital & facility affiliations

  • Bayada Home Health Care, Inc Home health agency, Charlotte, NC, CCN 347087
  • Atrium Health at Home University City Home health agency, Charlotte, NC, CCN 347254
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Atrium Health University City Hospital, Charlotte, NC, CCN 340166
  • Novant Health Huntersville Medical Center Hospital, Huntersville, NC, CCN 340183
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200100232NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2020 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 1, 2020 Accepting new patients
Atrium Health North Market Network LLC Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Carolinas Physicians Network Inc Family Medicine CurrentSince May 1, 2020 Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

101 E Wt Harris Blvd
Ste 5401
Charlotte, NC 28262
Phone (704) 863-1400

101 E Wt Harris Blvd
Ste 5002
Charlotte, NC 28262
Phone (704) 548-8724

4525 Cameron Valley Pkwy
Ste 4100D
Charlotte, NC 28211
Phone (704) 801-7310

10226 Couloak Dr
Ste 100
Charlotte, NC 28216
Phone (704) 801-7380

20036 Zion Ave
#100
Cornelius, NC 28031
Phone (704) 801-7400

12170 University City Blvd
Harrisburg, NC 28075
Phone (704) 455-9388

16455 Statesville Rd
Ste 360
Huntersville, NC 28078
Phone (704) 801-3300

9816 Sam Furr Rd
Ste 101
Huntersville, NC 28078
Phone (423) 343-7020

9611 Sherrill Estates Rd
Ste B
Huntersville, NC 28078
Phone (704) 801-1150

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

Interoperability endpoints

  • Direct secure messaging: jfaircloth411012@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1306861679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20036 ZION AVE",
            "address_2": "STE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318435",
            "telephone_number": "704-801-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E W T Harris Blvd",
            "address_2": "Ste 5401",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623485",
            "country_code": "US",
            "telephone_number": "704-863-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14214 Ballantyne Lake Rd",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282773372",
            "country_code": "US",
            "telephone_number": "704-667-2650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10226 Couloak Dr",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282167675",
            "country_code": "US",
            "telephone_number": "704-801-7380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9611 Sherrill Estates Rd",
            "address_2": "Ste B",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280786485",
            "country_code": "US",
            "telephone_number": "704-801-1150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRCLOTH",
        "first_name": "JACKIE",
        "middle_name": "REX",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2024-07-15",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200100232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

Verify at the official NPI Registry.