Individual provider Active NPI

Jesslyn Anika Anderson, FNP

  • Family Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1649677030
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5007354 Issued in NC
Practice address
501 Billingsley Rd
Cottage B
Charlotte, NC 28211-1009
Phone
(704) 444-5881
NPI assigned
Dec 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5007354 NC
Family Nurse Practitioner 363LF0000X 5007354 NC Primary

Addresses

Primary practice location

501 Billingsley Rd
Cottage B
Charlotte, NC 28211-1009

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6241

Other practice location 2

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-7070

Other practice location 3

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-0720

Other practice location 4

2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-6070

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address janderson412022@CarolinasHealthcareSystem.direct-ci.com Atrium Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150128002068 NC Practitioner - Nurse Practitioner 3779807425 Reassigns benefits to 4 organizations
I20151214002287 SC Practitioner - Nurse Practitioner 3779807425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1380 Ebenezer Rd
Suite E
Rock Hill, SC 29732-2349
Phone (803) 324-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5007354NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
On Site Care LLC Family CurrentSince Jan 15, 2018 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Columbus Regional Health Network CurrentSince Apr 6, 2015 Accepting new patients
Carolinas Medical Center CurrentSince Apr 16, 2016 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Apr 6, 2015 Accepting new patients
Columbus Regional Health Network CurrentSince Apr 6, 2015 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Scotland Regional Health Network CurrentSince Apr 6, 2015 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Apr 6, 2015 Accepting new patients
Carolinas Medical Center CurrentSince Apr 16, 2016 Accepting new patients
Scotland Regional Health Network CurrentSince Apr 6, 2015 Accepting new patients
Columbus Regional Health Network Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

501 Billingsley Rd
Charlotte, NC 28211
Phone (704) 358-2700

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

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

501 Billingsley Rd
#B
Charlotte, NC 28211
Phone (704) 444-2400

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

1380 Ebenezer Rd
Ste E
Rock Hill, SC 29732
Phone (803) 283-3686

Interoperability endpoints

  • Direct secure messaging: janderson412022@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: jesslyn.anderson.1@14940.direct.athenahealth.com

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1649677030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY RD",
            "address_2": "COTTAGE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-444-5881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 N Tryon St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623300",
            "country_code": "US",
            "telephone_number": "704-863-6241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10628 Park Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108407",
            "country_code": "US",
            "telephone_number": "704-667-7070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035812",
            "country_code": "US",
            "telephone_number": "704-355-0720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Vail Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071248",
            "country_code": "US",
            "telephone_number": "704-304-6070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JESSLYN",
        "middle_name": "ANIKA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-01",
        "last_updated": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5007354",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5007354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "janderson412022@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "501 Billingsley Rd",
            "address_2": "Cottage B",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282111009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.