NPIMap

Organization Active NPI

Mooresville PPM LLC

  • Surgery Physician
  • Mooresville, NC
National Provider Identifier
1598032849
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MOORESVILLE PPM LLC
Practice address
123 Professional Park Dr
Suite 200
Mooresville, NC 28117-5524
Phone
(704) 663-0006
Fax
(704) 663-5224
NPI assigned
Nov 30, 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. Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

123 Professional Park Dr
Suite 200
Mooresville, NC 28117-5524

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7230

Other identifiers 1

IdentifierTypeStateIssuer
5916618MedicaidNC

Other names 1

  • NorthPoint Surgical Specialists 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": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1598032849",
    "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": "615-465-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 PROFESSIONAL PARK DR",
            "address_2": "SUITE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175524",
            "telephone_number": "704-663-0006",
            "fax_number": "704-663-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2011-11-30",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916618",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthPoint Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorthPoint Surgical Specialists",
            "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.