Lake Norman Medical, PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LAKE NORMAN MEDICAL, PLLC

Practice address

1661 Davie Ave
Statesville, NC 28677-3519

Phone

(704) 495-2470

NPI assigned

Mar 9, 2020

Last updated

Oct 26, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ronald AdamsNPI 1629072350

Title

Authorized Official

Phone

(704) 495-2470

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronald Eugene Adams, DC

  • Chiropractor
  • Statesville, NC
  • NPI 1629072350
  NPD Authorized official
• Michelle Victoria Simonds

  • Registered Nurse
  • Charlotte, NC
  • NPI 1154916799
  Medicare reassignment
• Hemal V Mehta, MD

  • Physical Medicine & Rehabilitation Physician
  • Murfreesboro, TN
  • NPI 1174533772

  NC

  Medicare reassignment

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1699300822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773519",
            "telephone_number": "704-495-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773519",
            "telephone_number": "704-495-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NORMAN MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "704-495-2470"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lab704 LLC
• Catherine Laura Lackey
• Summer Elizabeth Lackey, PA
• Christie Edwards Ladd, RN
• Kimberly Ann Lafreniere, PA-C
• Kevin Michael Lamm
• Kristina Land
• Steven Jay Landau, M.D.
• Stephanie J Lane
• Bemilliam Lanier, LPN

• Physical Medicine & Rehabilitation Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Physical Medicine & Rehabilitation Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.