Renee M Hazelton, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103441 Issued in NC

Practice address

152 Sherlock Dr
Statesville, NC 28625-1916

Phone

(704) 838-8210

Fax

(704) 924-5359

NPI assigned

Aug 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2216/brand/1/csg/1/fhir/r4

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.

• Piedmont Healthcare, P.a.

  • Internal Medicine Physician
  • Statesville, NC
  • NPI 1912999897
  NPD
• Lake Norman Dermatology, PA

  • Specialist
  • Mooresville, NC
  • NPI 1184754848
  NPD (past)
• Waterside Dermatology and Laser Center PLLC

  • Dermatology Physician
  • Denver, NC
  • NPI 1477782076
  NPD (past)
• West Dermatology of Pennsylvania a Professional Medical Corporation

  • Dermatology Physician
  • Washington, PA
  • NPI 1821265943
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1881708006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845",
            "telephone_number": "704-838-8210",
            "fax_number": "704-924-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 SHERLOCK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286251916",
            "telephone_number": "704-838-8210",
            "fax_number": "704-924-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZELTON",
        "first_name": "RENEE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00131400",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00222657",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger Roshan Hatharasinghe, M.D.
• Barbara Jo Hayes, FNP
• Ishmael Robert Hayfron, DNP, FNP-C
• Sally Ironside Haynes, LMHC, MAC, EMDR CERT
• Susan Blackwelder Haynes, LCASA
• Alyssa English Head, PHYSICIAN ASSISTANT
• Claire Head, OD
• Maria Campbell Head, FNP-C
• Marilyn Virginia Heagney, CCC-SLP
• Health Services Unlimited

• Physician Assistant in Statesville, NC
• Providers in Statesville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.