Mooresville PPM LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOORESVILLE PPM LLC

Doing business as

Primary Care Associates of Lake Norman

Practice address

202 Williamson Rd
Suite 100
Mooresville, NC 28117-7610

Phone

(704) 799-7811

Fax

(704) 799-7812

NPI assigned

Nov 30, 2011

Organization subpart

Yes

Parent organization

MOORESVILLE PPM LLCAs reported in NPPES

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

Addresses

Other names 1

• Primary Care Associates of Lake Norman Doing business as

Part of

Mooresville PPM LLC

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul Emanuel Fagan, PA-C

  • Physician Assistant
  • Statesville, NC
  • NPI 1336437367
  NPD
• Brandi Lynne Forbes, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1376074468
  NPD
• Ashley Elizabeth Hawks, PA-C

  • Physician Assistant
  • Mooresville, NC
  • NPI 1285265488
  NPD
• Timothy P Kelley, PA-C

  • Physician Assistant
  • Mooresville, NC
  • NPI 1679654057
  NPD
• Kevin Bruce Vanhoy, PA

  • Physician Assistant
  • Mooresville, NC
  • NPI 1659374833
  NPD
• Thomas E Goodin IV, FNP

  • Family Nurse Practitioner
  • Claremont, NC
  • NPI 1669770723
  NPD (past)
• Timothy Adam Leone, DO

  • Surgery Physician
  • Statesville, NC
  • NPI 1043411259
  NPD (past)

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1861769119",
    "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": "202 WILLIAMSON RD",
            "address_2": "SUITE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177610",
            "telephone_number": "704-799-7811",
            "fax_number": "704-799-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2011-11-30",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Associates of Lake Norman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primary Care Associates of Lake Norman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mooresville PPM LLC (Lakeshore Internal Medicine)
• Mooresville PPM, LLC (Harbor Internal Mediciine)
• Mooresville Rescue Squad
• Mooresville Senior Living, LLC (Churchill Senior Living)
• Mooresville Sports & Physical Therapy, LLC

• Family Medicine Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Family Medicine Physician in North Carolina

• 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.

Verify at the official NPI Registry.