NPIMap

Individual provider Active NPI

Jacquelyn M Leak-Gillispie, NP-C

  • Adult Health Nurse Practitioner
  • Concord, NC
National Provider Identifier
1831255330
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
5002506 Issued in NC
Practice address
920 Church St N
Concord, NC 28025-2927
Phone
(704) 403-1430
Fax
(704) 403-1158
NPI assigned
Dec 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Management Registered Nurse 163WP0000X 5002506 NC
Adult Health Nurse Practitioner 363LA2200X 5002506 NC Primary

Addresses

Primary practice location

920 Church St N
Concord, NC 28025-2927

Mailing address

PO Box 2000
Concord, NC 28026-2000
Phone (704) 403-1430

Other practice location 1

1085 NE Gateway Ct NE
Concord, NC 28025-2406
Phone (704) 403-2525

Other names 1

  • Jacquelyn M Leak 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
I20070312000406 NC Practitioner - Nurse Practitioner 8820191893 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrium Health Specialty Network IncGroup PAC ID 5193245801, 248 clinicians

Practice addresses (Care Compare)

1085 NE Gateway CT NE
Concord, NC 28025-2406
Phone (704) 403-2525

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Anesthesia Services Group Inc CurrentSince Mar 13, 2021 Accepting new patients
Northeast Anesthesia and Pain Specialists PA CurrentSince Jan 2, 2007 Accepting new patients
Atrium Health Specialty Network Inc CurrentSince Jun 22, 2025 Accepting new patients
Hospice of Gaston County, Inc Past Accepting new patients

Locations

4525 Cameron Valley Pkwy
Charlotte, NC 28211
Phone (704) 355-5100

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

1085 NE Gateway Ct NE
Concord, NC 28025
Phone (704) 403-2525

1085 NE Gateway Ct NE
Ste 300
Concord, NC 28025
Phone (704) 403-1430

Interoperability endpoints

  • Direct secure messaging: jleakgillispie167677@carolinashealthcaresystem.direct-ci.com

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 and National Provider Directory roles.

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1831255330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280262000",
            "telephone_number": "704-403-1430",
            "fax_number": "704-403-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 CHURCH ST N",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252927",
            "telephone_number": "704-403-1430",
            "fax_number": "704-403-1158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1085 NE Gateway Ct NE",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252406",
            "country_code": "US",
            "telephone_number": "704-403-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEAK-GILLISPIE",
        "first_name": "JACQUELYN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-29",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "NC",
            "license": "5002506",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5002506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "LEAK",
            "middle_name": "M",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.