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LIFESOURCE OF NORTH CAROLINA
NPI 1619515277
Social Worker - Clinical in Holland, OH

Active since December 13, 2019
1525 EBER RD, HOLLAND, OH 43528(910) 742-9243(888) 746-1787 Get Directions Write a Review

NPPES record last updated: April 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 10, 2024, Nov 24, 2021, Mar 25, 2021 and 1 more (4 updates tracked since 2019).

About Lifesource Of North Carolina NPPES

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

LIFESOURCE OF NORTH CAROLINA (NPI 1619515277) is a healthcare organization registered as a clinical in Holland, Ohio and active in the NPI registry since December 2019. The organization lists Peggy Baddour, President, as its authorized official.

NPPES Registry Identity

NPI1619515277
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameLIFESOURCE OF NORTH CAROLINA
Location Address1525 EBER RDHolland, OH 43528-9616
Mailing AddressPo Box 538622Atlanta, GA 30353-8622 · (910) 535-1211 · Fax (919) 746-7603
Phone(910) 742-9243
Fax(888) 746-1787
Organization SubpartNo
Authorized OfficialPeggy BaddourPresident · (910) 777-9165
Enumeration DateDecember 13, 2019
Last NPPES UpdateApril 10, 20244 updates tracked since enumeration
NPPES CertifiedApril 10, 2024
✔ NPI 1619515277 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 7

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X
Also ListedSocial WorkerTaxonomy 104100000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
1525 EBER RD, Holland, OH 43528
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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 Anthem Blue Cross and Blue Shield, Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lifesource Of North Carolina is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Lifesource Of North Carolina, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians by Medicare Specialty 3

Nurse Practitioner5
Clinical Social Worker4
Psychiatry2

Clinicians, nearest first (11)

Gregg Stephens, LISW-S
Clinical Social Worker
NPI 1053508309
244 PADDOCK CT
Delaware, OH 43015
(567) 674-1886
✔ PECOS✔ Accepts Medicare97 mi
Jessica Fournier
Nurse Practitioner
NPI 1033857727
115 COMMERCE PARK DR
Westerville, OH 43082
(614) 360-2600
✔ PECOS✔ Accepts Medicare111 mi
Loraine Maguire, LISW
Clinical Social Worker
NPI 1174705420
774 PARK MEADOW RD
Westerville, OH 43081
(614) 882-9338
✔ PECOS113 mi
Ryan Peirson, M.D.
Psychiatry
NPI 1740381409
2510 5TH ST BLDG 840
Wright Pat, OH 45433
(937) 938-2766
✔ PECOS127 mi
Neal Dunsieth, M.D.
Psychiatry
NPI 1245324961
6460 HARRISON AVE
Cincinnati, OH 45247
(513) 941-4999
✔ PECOS✔ Accepts Medicare173 mi
Gretchen Horner, CNP
Nurse Practitioner
NPI 1962667691
1711 27TH ST STE 102
Portsmouth, OH 45662
(740) 356-1709
✔ PECOS✔ Accepts Medicare202 mi
Angela Ellison, LCSW
Clinical Social Worker
NPI 1871134999
1527 VALLEY DR
Flatwoods, KY 41139
(606) 465-3245
✔ PECOS✔ Accepts Medicare221 mi
Kelley Fulkerson, LCSW
Clinical Social Worker
NPI 1578942140
2817 VEACH RD
Owensboro, KY 42303
(270) 240-5312
✔ PECOS✔ Accepts Medicare320 mi
Bryce Yates, PMHNP-BC
Nurse Practitioner
NPI 1487184446
205 W SPRINGDALE AVE
Knoxville, TN 37917
(865) 637-9711
✔ PECOS✔ Accepts Medicare388 mi
Linda Cappiello, NURSE PRACTITIONER
Nurse Practitioner
NPI 1174633457
3205 RANDALL PKWY
Wilmington, NC 28403
(910) 742-9243
✔ PECOS✔ Accepts Medicare602 mi
Fariba Mazdeh, NP
Nurse Practitioner
NPI 1669786117
333 1ST ST STE A
San Francisco, CA 94105
(888) 803-3370
✔ PECOS2,057 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Lifesource Of North Carolina's NPI number?

The NPI number for Lifesource Of North Carolina is 1619515277. It was assigned to this organization in the NPPES registry on December 13, 2019.

Where is Lifesource Of North Carolina located?

Lifesource Of North Carolina is located at 1525 Eber Rd, Holland, OH 43528. The listed phone number is (910) 742-9243.

What is Lifesource Of North Carolina's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Lifesource Of North Carolina enrolled in Medicare?

Yes. Lifesource Of North Carolina is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lifesource Of North Carolina?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 3 Medicare specialties reassign their Medicare billing to Lifesource Of North Carolina. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (5), Clinical Social Worker (4) and Psychiatry (2). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Lifesource Of North Carolina accept?

Health plans from Anthem Blue Cross and Blue Shield and Molina Healthcare list Lifesource Of North Carolina 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 Lifesource Of North Carolina was last updated on April 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.