CLINT BEAVER (NPI# 1558565838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558565838 |
| Entity Type | Individual |
| Full Name | CLINT BEAVER |
| Credential | MD |
| Practice Address |
106 Corporate Park Dr Suite 200 & 300 Mooresville NC 28117-7134 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7042359090 |
| Practice Fax Number | 7042359101 |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-10-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 200901244 | NC | Allopathic & Osteopathic Physicians |
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
200901244 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5915044 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 150 Fairview Rd Ste 230, Mooresville, NC 281179508 | 4233437018 | |
| 130 Plantation Ridge Dr, Suite 100, Mooresville, NC 281179238 | 7043161635 | 7043161636 |
| Street Address |
106 CORPORATE PARK DR SUITE 200 & 300 |
| City | MOORESVILLE |
| State | NC |
| Zip Code | 28117-7134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194718403 | Stephanie B Elkins | Family Medicine | 106 Corporate Park Dr, Suite 200 & 300, Mooresville, NC 28117-7134 | 2005-08-23 |
| 1306292669 | Cody Elizabeth Homistek | Family Medicine | 106 Corporate Park Dr, Suite 200 & 300, Mooresville, NC 28117-7134 | 2016-05-05 |
| 1881050375 | Ginger Ambron | Nurse Practitioner | 106 Corporate Park Dr, Suite 200 & 300, Mooresville, NC 28117-7134 | 2016-01-13 |
| 1043299290 | Rebecca M Panuski | Family Medicine | 106 Corporate Park Dr, Suite 200 & 300, Mooresville, NC 28117-7134 | 2006-01-15 |
| 1053399071 | Bruce S Mather | Family Medicine | 106 Corporate Park Dr, Suite 200 & 300, Mooresville, NC 28117-7134 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891356648 | Teleoptometric Service, P.C. | Optometrist | 392 Talbert Rd, Mooresville, NC 28117 | 2019-06-24 |
| 1992268544 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 392 Talbert Rd., Mooresville, NC 28117 | 2019-04-10 |
| 1982178042 | Langtree Endoscopy Center, LLC | Clinic/Center | 106 Alexander Bank Drive, Suite 101, Mooresville, NC 28117 | 2019-01-11 |
| 1679044416 | May and Associates Therapy Center | Psychologist | 862 Brawley School Road, Suite 202, Mooresville, NC 28117 | 2018-12-05 |
| 1700360153 | Sabrina Chabot Hutchinson | Physical Therapist | 508 Williamson Rd, Suite 200, Mooresville, NC 28117 | 2018-09-21 |
| 1992284327 | Presbyterian Imaging Centers LLC | Radiology | 106 Langtree Village Dr # 201, Mooresville, NC 28117 | 2018-08-07 |
| 1073091310 | Jenelle Donzelli Nemeth | Registered Nurse | 102 Sapphire Drive, Mooresville, NC 28117 | 2018-07-30 |
| 1912497496 | Patsharx LLC | Pharmacy | 480 River Hwy, Suite A, Mooresville, NC 28117 | 2018-05-10 |
| 1427502434 | Counseling Service At Lake Norman, Pllc | Community/Behavioral Health | 18117 W. Catawba Avenue, Cornelius, NC 28117 | 2016-08-08 |
| 1447605928 | Renewal Counseling, Pllc | Counselor | 125 Commerce Park Rd., Suite 102, Mooresville, NC 28117 | 2016-05-03 |
| Find all providers in zip 28117 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868155 | Novant Medical Group, Inc. | Family Medicine | 106 Corporate Park Dr Ste 200, Mooresville, NC 28117-7134 | 2020-07-08 |
| 1649890468 | Carolinas Physicians Network Inc | Family Medicine | 150 Professional Park Dr Ste 400, Mooresville, NC 28117-5604 | 2020-04-22 |
| 1275080954 | Carolinas Physicians Network Inc | Family Medicine | 119-d-1 Marketplace Avenue, Mooresville, NC 28117-9157 | 2016-09-09 |
| 1063869469 | Amber Hicks-thibodeau | Family Medicine | 798 Oak Ridge Farm Hwy. Suite A, Mooresville, NC 28115 | 2016-05-16 |
| 1982043535 | Gabriel Cyrus Fitton | Family Medicine | 157 Professional Park Dr Ste A, Mooresville, NC 28117-5606 | 2013-06-17 |
| 1245573807 | Anthony John Castiglia | Family Medicine | 570 Williamson Rd, Suite C, Mooresville, NC 28117-9118 | 2013-04-02 |
| 1851678767 | Mooresville Ppm LLC | Family Medicine | 128 Argus Ln, Suite G, Mooresville, NC 28117-6972 | 2011-11-05 |
| 1790068096 | Urgent Cares of America North Carolina Inc. | Family Medicine | 107 Commons Dr Ste A, Mooresville, NC 28117-9262 | 2011-09-22 |
| 1780822288 | Iredell Physician Network LLC | Family Medicine | 136 Corporate Park Dr, Suite 3h, Mooresville, NC 28117-6959 | 2009-01-22 |
| 1275781726 | Carolinas Physicians Network, Inc. | Family Medicine | 478 Williamson Road, Ste B, Mooresville, NC 28117-9109 | 2008-09-08 |
| Find all providers in MOORESVILLE | ||||
| City | MOORESVILLE |
| Zip Code | 28117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.