Active NPI
Mooresville PPM LLC
- Family Medicine Physician
- Mooresville, NC
National Provider Identifier
1851678767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MOORESVILLE PPM LLC
- Practice address
- 128 Argus LN
Suite G
Mooresville, NC 28117-6972 - Phone
- (704) 663-1440
- Fax
- (704) 663-1445
- NPI assigned
- Nov 5, 2011
- Organization subpart
- Yes
- Parent organization
- MOORESVILLE PPM LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jennifer L Jackson
- Title
- Sr Dir Prov Enrollment & Onboarding
- Phone
- (615) 465-3334
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
128 Argus LN
Suite G
Mooresville, NC 28117-6972
Mailing address
4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5915049 | Medicaid | NC |
Other names 1
- Primary Care Associates of Byers Creek
National Provider Directory
National Provider Directory- Part of
- Mooresville PPM LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320451200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1642118400000",
"number": "1851678767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 MERIDIAN BLVD",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370676325",
"telephone_number": "615-465-7230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 ARGUS LN",
"address_2": "SUITE G",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281176972",
"telephone_number": "704-663-1440",
"fax_number": "704-663-1445"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOORESVILLE PPM LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
"enumeration_date": "2011-11-05",
"last_updated": "2022-01-14",
"certification_date": "2022-01-14",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
"authorized_official_telephone_number": "615-465-3334",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5915049",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Primary Care Associates of Byers Creek",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Primary Care Associates of Byers Creek",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.