NPIMap

Individual provider Active NPI

Joseph Matthew Micchia Jr., DO

  • Family Medicine Physician
  • Wake Forest, NC
National Provider Identifier
1699749408
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2005-01578 Issued in NC
Practice address
10500 Ligon Mill Rd
Suite 113
Wake Forest, NC 27587-6090
Phone
(919) 570-5705
Fax
(919) 570-5710
NPI assigned
Feb 16, 2006
Last updated
Oct 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X OS008793L PA
Family Medicine Physician 207Q00000X 2005-01578 NC Primary

Addresses

Primary practice location

10500 Ligon Mill Rd
Suite 113
Wake Forest, NC 27587-6090

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other identifiers 3

IdentifierTypeStateIssuer
142W7OtherNCBCBS
5905075MedicaidNC
011630849MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JMICCHIA16863@DIRECT.NOVANTHEALTH.ORG

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060923000037 NC Practitioner - Family Practice 6204831381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1994
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)

10500 Ligon Mill Rd
Suite 113
Wake Forest, NC 27587-4576
Phone (919) 570-5705

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS008793LPAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2010 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2010 Accepting new patients
Sleepworks, LLC CurrentSince Jan 1, 2013 Accepting new patients
Raleigh Durham Medical Group PA Family Medicine Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Covenant Family Medicine Family Medicine Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

445 S Kings Dr
Charlotte, NC 28204
Phone (704) 384-1734

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

10500 Ligon Mill Rd
Ste 113
Wake Forest, NC 27587
Phone (919) 570-5705

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: jmicchia16863@direct.novanthealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1699749408",
    "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": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 LIGON MILL RD",
            "address_2": "SUITE 113",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876090",
            "telephone_number": "919-570-5705",
            "fax_number": "919-570-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICCHIA",
        "first_name": "JOSEPH",
        "middle_name": "MATTHEW",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "OS008793L",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2005-01578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "142W7",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905075",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011630849",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JMICCHIA16863@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "10500 Ligon Mill Rd",
            "address_2": "Suite 113",
            "city": "Wake Forest",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275876090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

Verify at the official NPI Registry.