NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Lakeview OBGYN

  • Obstetrics & Gynecology Physician
  • Mooresville, NC
National Provider Identifier
1396070942
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Lakeview OBGYN
Practice address
136 Corporate Park Dr
Suite 3H
Mooresville, NC 28117-6959
Phone
(704) 660-9780
NPI assigned
Oct 14, 2009
Last updated
May 12, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Ms. Anna Purcell
Title
Director, Managed Care
Phone
(704) 878-4569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

136 Corporate Park Dr
Suite 3H
Mooresville, NC 28117-6959

Mailing address

PO Box 25867
Winston Salem, NC 27114-5867

Other identifiers 1

IdentifierTypeStateIssuer
5913307MedicaidNC

Other names 1

  • Lakeview OBGYN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory
Part of
Lakeview OBGYN

NPI Registry JSON

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

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1396070942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25867",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271145867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 CORPORATE PARK DR",
            "address_2": "SUITE 3H",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176959",
            "telephone_number": "704-660-9780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2009-10-14",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "DIRECTOR, MANAGED CARE",
        "authorized_official_telephone_number": "704-878-4569",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913307",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeview OBGYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.