NPIMap

Individual provider Active NPI

Anna Lillian Hallock, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1407545890
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-14039 Issued in NC
Practice address
4741 Randolph Rd Ste 100&200
Charlotte, NC 28211-2919
Phone
(704) 365-6730
Fax
(704) 365-6731
NPI assigned
May 2, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-14039 NC Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

4741 Randolph Rd Ste 100&200
Charlotte, NC 28211-2919

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

211 E Wilson St
Wingate, NC 28174-9664
Phone (704) 233-8000

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
I20240812001836 NC Practitioner - Physician Assistant 4789122581 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
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)

1901 Randolph Rd
Charlotte, NC 28207-1101
Phone (704) 316-2000

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

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

4741 Randolph Rd
Charlotte, NC 28211-2919
Phone (704) 365-6730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2025 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2025 Accepting new patients
Fastmed Primary Care, P.C. Past Accepting new patients

Locations

4741 Randolph Rd
Ste 100200
Charlotte, NC 28211
Phone (704) 365-6730

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

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

Interoperability endpoints

  • Direct secure messaging: ahallock1092604@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: ahallock1734919@direct.novanthealth.org

Organizations & group practices 6

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 5

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": "1682985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1407545890",
    "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": "4741 RANDOLPH RD STE 100&200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112919",
            "telephone_number": "704-365-6730",
            "fax_number": "704-365-6731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 E Wilson St",
            "address_purpose": "LOCATION",
            "city": "Wingate",
            "state": "NC",
            "postal_code": "281749664",
            "country_code": "US",
            "telephone_number": "704-233-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALLOCK",
        "first_name": "ANNA",
        "middle_name": "LILLIAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-02",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14039",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.