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NORTHLAKE PEDIATRIC CARE PA
NPI 1083729701
Pediatrics in Statesville, NC

Active since August 20, 2006CLIA 34D1014813 · Waiver
2117 SIMONTON RD, SUITE 402, STATESVILLE, NC 28625(704) 871-2323(803) 619-2149 Get Directions Write a Review

NPPES record last updated: May 30, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Northlake Pediatric Care Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHLAKE PEDIATRIC CARE PA (NPI 1083729701) is a healthcare organization registered as a pediatrics in Statesville, North Carolina and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through July 16, 2027 and lists Michael Borja, Owner, as its authorized official.

NPPES Registry Identity

NPI1083729701
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameNORTHLAKE PEDIATRIC CARE PA
Location Address2117 SIMONTON RD, SUITE 402Statesville, NC 28625-8206
Mailing Address2117 Simonton Rd, Suite 402Statesville, NC 28625-8206 · (704) 871-2323 · Fax (803) 619-2149
Phone(704) 871-2323
Fax(803) 619-2149
Organization SubpartNo
Authorized OfficialMichael BorjaOwner · (704) 871-2323
Enumeration DateAugust 20, 2006
Last NPPES UpdateMay 30, 2013
✔ NPI 1083729701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
2117 SIMONTON RD, Statesville, NC 28625
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Other Identifiers 3

Other1002PNC · Bcbs Of Nc
Medicaid5918872NC
Other34D1014813Clia Id

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D1014813

Northlake Pediatric Care PA · Statesville, NC
Active · expires Jul 16, 2027
CLIA Number34D1014813
Laboratory TypePhysician Office
Certificate Effective DateJuly 17, 2025
Certificate Expiration DateJuly 16, 2027
Laboratory DirectorMichael G. Borja
Laboratory Phone(704) 871-9731
Laboratory LocationNorthlake Pediatric Care PA2117 Simonton Road, Ste #402, Statesville, NC 28625
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL BORJA MD
Pediatrics
2117 SIMONTON RD, SUITE 402
STATESVILLE, NC 28625
Iredell County (704) 871-2323
DR. PERRY STEPHEN JUSTICE JR. D.D.S.
Dentist (General Practice)
2117 SIMONTON RD, SUITE 403
STATESVILLE, NC 28625
Iredell County (704) 873-8899
WILLIE ROSCOE WHITAKER M.D.
Internal Medicine (Nephrology)
2117 SIMONTON RD, SUITE 102
STATESVILLE, NC 28625
Iredell County (704) 872-8422
PERRY S JUSTICE JR DDS PA
Dentist (General Practice)
2117 SIMONTON RD, SUITE 403
STATESVILLE, NC 28625
Iredell County (704) 873-8899

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northlake Pediatric Care PA's NPI number?

The NPI number for Northlake Pediatric Care PA is 1083729701. It was assigned to this organization in the NPPES registry on August 20, 2006.

Where is Northlake Pediatric Care PA located?

Northlake Pediatric Care PA is located at 2117 Simonton Rd Suite 402, Statesville, NC 28625. The listed phone number is (704) 871-2323.

What is Northlake Pediatric Care PA's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Northlake Pediatric Care PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1014813) is associated with this NPI, valid through July 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Northlake Pediatric Care PA accept?

Health plans from Blue Cross and Blue Shield of NC list Northlake Pediatric Care PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northlake Pediatric Care PA was last updated on May 30, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.