NPIMap

Organization Active NPI

Mooresville PPM LLC

Doing business as Lakeshore Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Mooresville, NC
National Provider Identifier
1710384466
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MOORESVILLE PPM LLC
Doing business as
Lakeshore Endocrinology
Practice address
134 Medical Park Rd
Suite 108
Mooresville, NC 28117-8526
Phone
(704) 660-4669
Fax
(704) 660-4295
NPI assigned
Nov 24, 2014
Last updated
Jan 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MOORESVILLE PPM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU Primary

Addresses

Primary practice location

134 Medical Park Rd
Suite 108
Mooresville, NC 28117-8526

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7230

Other names 1

  • Lakeshore Endocrinology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mooresville PPM LLC7 organizations share this tax ID, including this one
Part of
Mooresville PPM LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1710384466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MEDICAL PARK RD",
            "address_2": "SUITE 108",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178526",
            "telephone_number": "704-660-4669",
            "fax_number": "704-660-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2014-11-24",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.