NPIMap

Organization Active NPI

Mooresville PPM, LLC

  • Internal Medicine Physician
  • Mooresville, NC
National Provider Identifier
1497031322
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOORESVILLE PPM, LLC
Practice address
478 Williamson Rd
Suite B
Mooresville, NC 28117-8192
Phone
(704) 660-0321
Fax
(704) 660-0765
NPI assigned
Oct 24, 2011
Organization subpart
Yes
Parent organization
MOORESVILLE PPM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Mrs. Jenny L Jackson
Title
Sr Dir Prov Enrollmment & Onboardin
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

478 Williamson Rd
Suite B
Mooresville, NC 28117-8192

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-3334

Other names 1

  • Harbor Internal Mediciine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mooresville PPM LLC7 organizations share this tax ID, including this one
Part of
Mooresville PPM LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1497031322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 WILLIAMSON RD",
            "address_2": "SUITE B",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178192",
            "telephone_number": "704-660-0321",
            "fax_number": "704-660-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM, LLC",
        "enumeration_date": "2011-10-24",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMMENT & ONBOARDIN",
        "authorized_official_telephone_number": "615-465-3334",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Internal Mediciine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harbor Internal Mediciine",
            "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 Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.