Lifesource Prime Inc - Medicare Primary Care in Wilmington, NC

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Lifesource Prime Inc is a medicare enrolled primary clinic (Family Medicine) in Wilmington, North Carolina. The current practice location for Lifesource Prime Inc is 3205 Randall Pkwy Ste 105, Wilmington, North Carolina. For appointments, you can reach them via phone at (910) 742-9243. The mailing address for Lifesource Prime Inc is Po Box 538622, Atlanta, Georgia and phone number is (910) 338-2882.

Lifesource Prime Inc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1598533275. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (910) 742-9243.

Contact Information

Lifesource Prime Inc
3205 Randall Pkwy Ste 105
Wilmington
NC 28403-2565
(910) 742-9243
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameLifesource Prime Inc
SpecialityFamily Medicine
Location3205 Randall Pkwy Ste 105, Wilmington, North Carolina
Authorized Official Name and PositionPeggy Baddour (CEO)
Authorized Official Contact9107429243
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Lifesource Prime Inc
Po Box 538622
Atlanta
GA 30353-8622

Ph: (910) 338-2882		Lifesource Prime Inc
3205 Randall Pkwy Ste 105
Wilmington
NC 28403-2565

Ph: (910) 742-9243

NPI Details:

NPI Number1598533275
Provider Enumeration Date12/13/2023
Last Update Date12/27/2023

Medicare PECOS Information:

Medicare PECOS PAC ID7810336385
Medicare Enrollment IDO20240416003922

Medical Identifiers

Medical identifiers for Lifesource Prime Inc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1598533275NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Lifesource Prime Inc acts as a billing entity for following providers:
Provider NameJames William Earnhardt
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1992756019
PECOS PAC ID: 3779569991
Enrollment ID: I20040628001383
Provider NameSachin S Mody
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1730106444
PECOS PAC ID: 7214932482
Enrollment ID: I20070409000492
Provider NameKaren Stukes
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1831376433
PECOS PAC ID: 0244314524
Enrollment ID: I20080226000122
Provider NameCynthia K Honeycutt
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1528215407
PECOS PAC ID: 3375602980
Enrollment ID: I20081111000281
Provider NameJanet L Poindexter
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1578564803
PECOS PAC ID: 7618967282
Enrollment ID: I20090117000112
Provider NameMonica B Massey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1720256928
PECOS PAC ID: 8022289123
Enrollment ID: I20110921000677
Provider NameRebecca Spring Stevens
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1275968216
PECOS PAC ID: 7416182795
Enrollment ID: I20131022000507
Provider NameJatel Shukla
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467854224
PECOS PAC ID: 6204154628
Enrollment ID: I20150415002118
Provider NameMegan Katherine Blankenship
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1366969834
PECOS PAC ID: 4880960970
Enrollment ID: I20171017002159
Provider NameJennifer Lauren Nelson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1740762947
PECOS PAC ID: 0547513574
Enrollment ID: I20181022001455
Provider NameJulia Marie Cibula
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1649458787
PECOS PAC ID: 2466421706
Enrollment ID: I20181120000072
Provider NameAndrea Unzelmann Putnam
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376011403
PECOS PAC ID: 1355687708
Enrollment ID: I20190107002266
Provider NameMegan D Long
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1952950859
PECOS PAC ID: 0941633382
Enrollment ID: I20191126000062
Provider NameNacole H Wood
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356932974
PECOS PAC ID: 8729495130
Enrollment ID: I20210401000379
Provider NameIshan Bhansaly
Provider TypePractitioner - Hospitalist
Provider IdentifiersNPI Number: 1972824357
PECOS PAC ID: 6507004157
Enrollment ID: I20220203001128
Provider NameDiana Marmolejos
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467094821
PECOS PAC ID: 6204260979
Enrollment ID: I20230112001229
Provider NamePatricia Kpan Yates
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1104018969
PECOS PAC ID: 0648641936
Enrollment ID: I20230124003168
Provider NameCherise Dailey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1396445854
PECOS PAC ID: 6901271519
Enrollment ID: I20230413001496
Provider NameKari A Spencer
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1457929903
PECOS PAC ID: 3779946124
Enrollment ID: I20230831004196
Provider NameMegan Wolff
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1568114650
PECOS PAC ID: 2466831524
Enrollment ID: I20230918002735
Provider NameDebra Denise Arthur Turner
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376258384
PECOS PAC ID: 9436699469
Enrollment ID: I20240905001744
Provider NameChacey Bryan
Provider TypePractitioner - General Practice
Provider IdentifiersNPI Number: 1699228734
PECOS PAC ID: 9234425885
Enrollment ID: I20241009002580

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.