NPIMap

Individual provider Active NPI

Equilla Rena Lewis, NP

  • Family Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1770206591
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5017121 Issued in NC
Practice address
103 Country Club Dr
Fayetteville, NC 28301-7603
Phone
(910) 400-7002
NPI assigned
Sep 26, 2022
Last updated
Apr 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5017121 NC Primary

Addresses

Primary practice location

103 Country Club Dr
Fayetteville, NC 28301-7603

Mailing address

PO Box 746724
Atlanta, GA 30374-6724
Phone (312) 733-9730

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
I20230208002360 NC Practitioner - Nurse Practitioner 0840662482 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh Mi Physicians Group, PCGroup PAC ID 7810282191, 154 clinicians

Practice addresses (Care Compare)

103 Country Club Dr
Fayetteville, NC 28301-7603
Phone (910) 400-7002

3250 Freedom Dr
Charlotte, NC 28208-2817
Phone (704) 709-6009

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Smith & Kolb Family Practice, PLLC Family Current Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Nov 21, 2023 Accepting new patients
Osh-Mi Physicians Group PC Family CurrentSince Sep 14, 2023 Accepting new patients
Osh Mi Physicians Group, PC CurrentSince Sep 14, 2023 Accepting new patients

Locations

3250 Freedom Dr
Charlotte, NC 28208
Phone (704) 394-0118

103 Country Club Dr
Fayetteville, NC 28301
Phone (910) 400-7002

555 Fayetteville St
Raleigh, NC 27601
Phone (682) 268-1011

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25646/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1770206591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746724",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746724",
            "telephone_number": "312-733-9730",
            "fax_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 COUNTRY CLUB DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283017603",
            "telephone_number": "910-400-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "EQUILLA",
        "middle_name": "RENA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5017121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.