NPIMap

Organization Active NPI

Mooresville PPM LLC

Doing business as Lakeshore Internal Medicine

  • Internal Medicine Physician
  • Mooresville, NC
National Provider Identifier
1912287467
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOORESVILLE PPM LLC
Doing business as
Lakeshore Internal Medicine
Practice address
157 Professional Park Dr
Suite a
Mooresville, NC 28117-5605
Phone
(704) 662-3967
Fax
(704) 662-3975
NPI assigned
Aug 27, 2011
Organization subpart
Yes
Parent organization
MOORESVILLE PPM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

157 Professional Park Dr
Suite a
Mooresville, NC 28117-5605

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7000

Other names 1

  • Lakeshore Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mooresville PPM LLC7 organizations share this tax ID, including this one
Part of
Mooresville PPM LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1314403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1912287467",
    "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": "615-465-7000",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 PROFESSIONAL PARK DR",
            "address_2": "SUITE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175605",
            "telephone_number": "704-662-3967",
            "fax_number": "704-662-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2011-08-27",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore Internal Medicine",
            "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.

Verify at the official NPI Registry.