NPIMap

Individual provider Active NPI

Jessica Leigh Mack, ACNP

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1457994097
Registry record updated Oct 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5012459 Issued in NC
Practice address
1 Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2011
NPI assigned
Oct 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 254774 NC
Critical Care Medicine Nurse Practitioner 363LC0200X 5012459 NC
Nurse Practitioner 363L00000X 5012459 NC Primary

Addresses

Primary practice location

1 Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

5515 Old Meadow Rd
Charlotte, NC 28227-2677
Phone (828) 289-9211

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
I20191211001047 NC Practitioner - Nurse Practitioner 5698108389 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians

Practice addresses (Care Compare)

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 355-7328

1370 W D St
North Wilkesboro, NC 28659-3506
Phone (336) 651-8760

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
254774NCMDCritical Care Medicine (Internal Medicine) Physician
5012459NCMDCritical Care Medicine Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 18, 2024 Accepting new patients
Wake Forest University Health Sciences CurrentSince Nov 1, 2019 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Wake Forest University Health Sciences CurrentSince Nov 1, 2019 Accepting new patients
Carolinas Medical Center CurrentSince Jan 18, 2024 Accepting new patients
Carolinas Medical Center Critical Care Medicine CurrentSince Jan 18, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Critical Care Medicine CurrentSince Jan 18, 2024 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

1370 W D St
North Wilkesboro, NC 28659
Phone (336) 651-8100

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: jmack2753323@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 6

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": "1572134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1457994097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5515 OLD MEADOW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282272677",
            "telephone_number": "828-289-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JESSICA",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-27",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "254774",
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "NC",
            "license": "5012459",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.