Individual provider Active NPI

Korsica Lassiter Mebane, MD

  • Vascular Surgery Physician
  • Hickory, NC
National Provider Identifier
1689093361
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
2021-02443 Issued in NC
Practice address
Frye Regional Medical Center
420 N Center Street
Hickory, NC 28601
Phone
(828) 315-3036
NPI assigned
Apr 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 2021-02443 NC Primary

Addresses

Primary practice location

Frye Regional Medical Center
420 N Center Street
Hickory, NC 28601

Mailing address

3844 10TH St NE
Hickory, NC 28601-9683
Phone (919) 259-0841

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210907000998 NC Practitioner - Vascular Surgery 2163828716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Brody School of Medicine at East Carolina University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DLP Frye Medical Group LLCGroup PAC ID 8123397601, 125 clinicians

Practice addresses (Care Compare)

415 N Ctr St
Hickory, NC 28601-5036

915 Tate Blvd SE
Hickory, NC 28602-4042

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)17
Removal of tissue27
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2021-02443NCMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Frye Medical Group LLC CurrentSince Sep 1, 2021 Accepting new patients
DLP Frye Medical Group LLC Vascular Surgery CurrentSince Sep 1, 2021 Accepting new patients

Locations

915 Tate Blvd SE
Ste 186
Hickory, NC 28602
Phone (828) 449-8458

915 Tate Blvd SE
Ste 182
Hickory, NC 28602
Phone (828) 322-2005

415 N Center St
Ste 203
Hickory, NC 28601
Phone (828) 322-2005

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: korsica.mebane.1@15786.direct.athenahealth.com

Organizations & group practices 2

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 5

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": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1689093361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3844 10TH ST NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286019683",
            "telephone_number": "919-259-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FRYE REGIONAL MEDICAL CENTER",
            "address_2": "420 N CENTER STREET",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "28601",
            "telephone_number": "828-315-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEBANE",
        "first_name": "KORSICA",
        "middle_name": "LASSITER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2022-06-08",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NC",
            "license": "2021-02443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.