NPIMap

Individual provider Active NPI

Macy Renae Osborn, MD

  • Family Medicine Physician
  • Mooresville, NC
National Provider Identifier
1750945978
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2022-00706 Issued in NC
Practice address
106 Langtree Village Dr Ste 200
Mooresville, NC 28117-7594
Phone
(704) 384-7101
Fax
(704) 384-7102
NPI assigned
Apr 23, 2019
Last updated
Aug 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 250274 NC
Family Medicine Physician 207Q00000X 2022-00706 NC Primary

Addresses

Primary practice location

106 Langtree Village Dr Ste 200
Mooresville, NC 28117-7594

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

8560 Cook St
MT Pleasant, NC 28124-7686
Phone (704) 436-6521

Other names 1

  • Macy Renae Frye Former name

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
I20220805002561 NC Practitioner - Family Practice 2365777554 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
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, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
250274NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Feb 1, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 1, 2022 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

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

10816 Black Dog Ln
Ste 160
Charlotte, NC 28214
Phone (704) 316-3970

19485 Old Jetton Rd
Ste 100
Cornelius, NC 28031
Phone (704) 316-5170

19830 Zion Ave
Cornelius, NC 28031
Phone 7043841782 ext. 70438

14330 Oakhill Park Ln
Ste 200B
Huntersville, NC 28078
Phone (704) 316-1120

16525 Holly Crest Ln
Ste 150
Huntersville, NC 28078
Phone (704) 384-1725

6909 Prosperity Church Rd
Huntersville, NC 28078
Phone (704) 316-1830

106 Langtree Village Dr
Ste 200
Mooresville, NC 28117
Phone (704) 316-5570

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

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

Interoperability endpoints

  • Direct secure messaging: mosborn1076445@direct.novanthealth.org

Organizations & group practices 6

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": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1750945978",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LANGTREE VILLAGE DR STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177594",
            "telephone_number": "704-384-7101",
            "fax_number": "704-384-7102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8560 Cook St",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "NC",
            "postal_code": "281247686",
            "country_code": "US",
            "telephone_number": "704-436-6521",
            "fax_number": "704-436-9505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSBORN",
        "first_name": "MACY",
        "middle_name": "RENAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "250274",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2022-00706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACY",
            "last_name": "FRYE",
            "middle_name": "RENAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.