Ivy Lane Ziccarelli, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06261 Issued in NC

Practice address

1401 Matthews Township Pkwy Ste 320
Matthews, NC 28105

Phone

(704) 384-1261

Fax

(704) 384-3145

NPI assigned

Jan 6, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment Care Compare group
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Medical Group, Inc

  dba Novant Health Rehabilitation Center

  • Physical Therapist
  • Charlotte, NC
  • NPI 1649786575
  NPD
• Ceh

  • Health Maintenance Organization
  • Matthews, NC
  • NPI 1871024893
  NPD (past)
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1629434691",
    "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",
            "telephone_number": "704-384-1261",
            "fax_number": "704-384-3145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MATTHEWS TOWNSHIP PKWY STE 320",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-384-1261",
            "fax_number": "704-384-3145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10801 Monroe Rd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281058335",
            "country_code": "US",
            "telephone_number": "704-237-4240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "NOVANT HEALTH PSYCHIATRIC ASSOCIATES",
            "address_2": "1401 MATTHEWS TOWNSHIP PKWY; STE 320",
            "address_purpose": "LOCATION",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055403",
            "country_code": "US",
            "telephone_number": "704-384-1261",
            "fax_number": "704-384-3145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZICCARELLI",
        "first_name": "IVY",
        "middle_name": "LANE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-06",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iziccarelli680487@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "NOVANT HEALTH PSYCHIATRIC ASSOCIATES",
            "address_2": "1401 MATTHEWS TOWNSHIP PKWY; STE 320",
            "city": "MATTHEWS",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281055403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Noah T Zacharko, PT,DPT,MPT
• Adam Zalewski, PHARMD
• Wansi Bernadette Zedom, MD
• Guangbin Zeng, MD
• Yi Zeng
• Panagiotis Ziozios
• David Allen Zito, LPT
• Irina Zlochevskaya, PHARMD

• Physician Assistant in Matthews, NC
• Providers in Matthews, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.