NPIMap

Individual provider Active NPI

Susan Nicole McInnis, FNP-C

  • Nurse Practitioner
  • Wilmington, NC
National Provider Identifier
1396034310
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5005114 Issued in NC
Practice address
1090 Medical Center Dr
Wilmington, NC 28401-7353
Phone
(910) 662-8550
Fax
(910) 343-1924
NPI assigned
Mar 30, 2011
Last updated
Jul 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5005114 NC Primary
Family Nurse Practitioner 363LF0000X 5005114 NC

Addresses

Primary practice location

1090 Medical Center Dr
Wilmington, NC 28401-7353

Mailing address

PO Box 936857
Atlanta, GA 31193-6857
Phone (910) 662-8550

Other practice location 1

1414 Physicians Dr
Wilmington, NC 28401
Phone (910) 796-7900

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
I20110518000640 NC Practitioner - Nurse Practitioner 6406032937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1090 Medical Ctr Dr
Wilmington, NC 28401-7353
Phone (910) 662-8550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5005114NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
NMG Health Services LLC CurrentSince Aug 18, 2023 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Aug 18, 2023 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

1333 S Dickinson Dr
Unit 230
Leland, NC 28451
Phone (910) 254-1033

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1090 Medical Center Dr
Wilmington, NC 28401
Phone (910) 343-3345

Interoperability endpoints

  • Direct secure messaging: smcinnis1249190@direct.novanthealth.org

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 4

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": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1396034310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857",
            "telephone_number": "910-662-8550",
            "fax_number": "910-343-1924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017353",
            "telephone_number": "910-662-8550",
            "fax_number": "910-343-1924"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 Physicians Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28401",
            "country_code": "US",
            "telephone_number": "910-796-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCINNIS",
        "first_name": "SUSAN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5005114",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.