NPIMap

Individual provider Active NPI

Elizabeth Warren Desandre, NP

  • Nurse Practitioner
  • Bolivia, NC
National Provider Identifier
1821678368
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5014307 Issued in NC
Practice address
584 Hospital Dr NE Unit D
Bolivia, NC 28422-0020
Phone
(910) 721-4150
Fax
(910) 721-4159
NPI assigned
Apr 9, 2021
Last updated
Jul 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5014307 NC Primary
Registered Nurse 163W00000X 272250 NC

Addresses

Primary practice location

584 Hospital Dr NE Unit D
Bolivia, NC 28422-0020

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

240 Hospital Dr NE
Bolivia, NC 28422-8346
Phone (910) 269-9225

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dsessoms200289@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
I20210625000043 NC Practitioner - Nurse Practitioner 6800297094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

584 Hospital Nedr D
Bolivia, NC 28422-9047
Phone (910) 721-4150

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5014307NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 20, 2021 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 20, 2021 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

240 Hospital Dr NE
Bolivia, NC 28422
Phone (336) 399-7678

584 Hospital Dr NE
Unit D
Bolivia, NC 28422
Phone (910) 721-4150

75 Emerson Bay Rd
Ste 104
Carolina Shores, NC 28467
Phone (910) 667-3000

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: dsessoms200289@direct.novanthealth.org

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 8

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": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1821678368",
    "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": "584 HOSPITAL DR NE UNIT D",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284220020",
            "telephone_number": "910-721-4150",
            "fax_number": "910-721-4159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 Hospital Dr NE",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284228346",
            "country_code": "US",
            "telephone_number": "910-269-9225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESANDRE",
        "first_name": "ELIZABETH",
        "middle_name": "WARREN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5014307",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "272250",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dsessoms200289@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "584 Hospital Dr NE Unit D",
            "city": "Bolivia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284220020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bolivia, NC

Sources for this page

Verify at the official NPI Registry.