Individual provider Active NPI

Lisa Sims Mills, M.D.

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1841417649
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
200900234 Issued in NC
Practice address
2630 E 7TH St
Charlotte, NC 28204-4318
Phone
(704) 384-7508
Fax
(704) 384-8666
NPI assigned
Apr 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 200900234 NC Primary

Addresses

Primary practice location

2630 E 7TH St
Charlotte, NC 28204-4318

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7508

Other identifiers 2

IdentifierTypeStateIssuer
NC1049MedicaidSC
5912001MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lmills46209@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161018001195 NC Practitioner - Pediatric Medicine 6608013263 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200900234NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince May 30, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Pediatrics CurrentSince May 30, 2023 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1718 E 4th St
Ste 707
Charlotte, NC 28204
Phone (704) 316-4485

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

2630 E 7th St
Ste 101
Charlotte, NC 28204
Phone (704) 344-1000

Interoperability endpoints

  • Direct secure messaging: lmills46209@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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1841417649",
    "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",
            "telephone_number": "704-384-7508",
            "fax_number": "704-384-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 E 7TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282044318",
            "telephone_number": "704-384-7508",
            "fax_number": "704-384-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLS",
        "first_name": "LISA",
        "middle_name": "SIMS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200900234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1049",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912001",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmills46209@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "2630 E 7th St",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282044318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.