NPIMap

Organization Active NPI

Statesville Hma Medical Group LLC

  • Family Medicine Physician
  • Mocksville, NC
National Provider Identifier
1942942842
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STATESVILLE HMA MEDICAL GROUP LLC
Practice address
1102 Yadkinville Rd Ste a-B
Mocksville, NC 27028-2037
Phone
(704) 660-4693
NPI assigned
Apr 11, 2022
Organization subpart
Yes
Parent organization
STATESVILLE HMA MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Sandra Bales
Title
Credentialing Coordinator
Phone
(704) 660-4524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1102 Yadkinville Rd Ste a-B
Mocksville, NC 27028-2037

Mailing address

131 Medical Park Rd Ste 302
Mooresville, NC 28117-8525
Phone (704) 660-4524

National Provider Directory

National Provider Directory
Tax ID family
Statesville Hma Medical Gro15 organizations share this tax ID, including this one
Part of
Statesville Hma Medical Gro

Other organizations with this tax ID 14

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

View all 14

Locations

1102 Yadkinville Rd
Ste Ab
Mocksville, NC 27028
Phone (336) 936-6083

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1942942842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 MEDICAL PARK RD STE 302",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178525",
            "telephone_number": "704-660-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 YADKINVILLE RD STE A-B",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282037",
            "telephone_number": "704-660-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESVILLE HMA MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATESVILLE HMA MEDICAL GROUP LLC",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "BALES",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "704-660-4524"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mocksville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.