NPIMap

Individual provider Active NPI

Ma Cornelia Villavicencio Leano, NURSE PRACTITIONER

  • Gerontology Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1780179580
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
LEAN-18CO92 Issued in NC
Practice address
3081 Stone Carriage Cir Apt Z
Fayetteville, NC 28304
Phone
(818) 675-0386
NPI assigned
Jun 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X LEAN-18CO92 NC
Gerontology Nurse Practitioner 363LG0600X LEAN-18CO92 NC Primary

Addresses

Primary practice location

3081 Stone Carriage Cir Apt Z
Fayetteville, NC 28304

Mailing address

3081 Stone Carriage Cir Apt Z
Fayetteville, NC 28304-5591
Phone (818) 675-0386

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
I20180910001792 NC Practitioner - Nurse Practitioner 8729338918 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Eventus Wholehealth PLLCGroup PAC ID 6002169539, 301 clinicians
Optimed HospitalistsGroup PAC ID 8022204171, 47 clinicians
Eventus WH Southeast, LLCGroup PAC ID 5496294456, 241 clinicians

Practice addresses (Care Compare)

101 Cabarrus Ave E
Suite 200
Concord, NC 28025-3781
Phone (855) 743-2247

1404 N Lafayette St
Shelby, NC 28150-3406
Phone (980) 487-1500

212 S Tryon St
Suite 1000
Charlotte, NC 28281-0006
Phone (855) 743-2247

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LEAN-18CO92NCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optimed Hospitalists Current Accepting new patients
Eventus Value Care, LLC CurrentSince Nov 1, 2021 Accepting new patients
Alignmed Partners, PC CurrentSince Feb 26, 2021 Accepting new patients
Eventus Wholehealth, PLLC Adult Health CurrentSince Nov 16, 2020 Accepting new patients
Eventus WH PLLC Care, LLC CurrentSince Sep 1, 2025 Accepting new patients
Optimed Hospitalists CurrentSince Jun 12, 2021 Accepting new patients
Eventus WH Southeast, LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

625 Bethany Rd
Albemarle, NC 28001
Phone (704) 982-0770

2810 Coliseum Centre Dr
Ste 120
Charlotte, NC 28217

212 S Tryon St
Ste 1000
Charlotte, NC 28281
Phone (512) 575-8028

707 N Elm St
High Point, NC 27262
Phone (336) 885-0141

877 Hill Everhart Rd
Lexington, NC 27295
Phone (336) 248-6644

1404 N Lafayette St
Shelby, NC 28150
Phone (704) 480-0128

557 Brookdale Dr
Statesville, NC 28677
Phone (330) 445-4361

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1780179580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3081 STONE CARRIAGE CIR APT Z",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283045591",
            "telephone_number": "818-675-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3081 STONE CARRIAGE CIR APT Z",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28304",
            "telephone_number": "818-675-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEANO",
        "first_name": "MA CORNELIA",
        "middle_name": "VILLAVICENCIO",
        "name_prefix": "Miss",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "LEAN-18CO92",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "LEAN-18CO92",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.