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SOUTHERN FAMILY MEDICINE, INC.
NPI 1881144590
Community/Behavioral Health in Mooresville, NC

Active since October 05, 2016CLIA Certified · 3 labs
400 E STATESVILLE AVE STE 200, MOORESVILLE, NC 28115(704) 360-8486(704) 230-4674 Get Directions Write a Review

NPPES record last updated: January 14, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 14, 2026, Aug 19, 2024, Jun 19, 2023 and 8 more (11 updates tracked since 2016).

About Southern Family Medicine, Inc. NPPES

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

SOUTHERN FAMILY MEDICINE, INC. (NPI 1881144590) is a healthcare organization registered as a community/behavioral health in Mooresville, North Carolina and active in the NPI registry since October 2016. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Angela Jarvis Micolucci, Ceo, as its authorized official.

NPPES Registry Identity

NPI1881144590
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameSOUTHERN FAMILY MEDICINE, INC.
Location Address400 E STATESVILLE AVE STE 200Mooresville, NC 28115-2588
Mailing Address400 E Statesville Ave Ste 200Mooresville, NC 28115-2588 · (704) 360-8486 · Fax (704) 230-4674
Phone(704) 360-8486
Fax(704) 230-4674
Organization SubpartNo
Authorized OfficialAngela Jarvis MicolucciCeo · (704) 953-4890
Enumeration DateOctober 5, 2016
Last NPPES UpdateJanuary 14, 202611 updates tracked since enumeration
NPPES CertifiedJanuary 14, 2026
✔ NPI 1881144590 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
400 E STATESVILLE AVE STE 200, Mooresville, NC 28115
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Secondary Practice Locations 2

Location 1160 Baker RdHigh Point, NC 27263-2758 · Phone (336) 307-4075 · Fax (363) 307-3745
Location 2121 Country LnMocksville, NC 27028-2588 · Phone (336) 677-3900 · Fax (336) 677-3909

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 Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.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)

Southern Family Medicine, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Southern Family Medicine, Inc., which bills Medicare for the services they deliver. Of these, 3 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Bethany Basnett, NP
Nurse Practitioner
NPI 1487718938
400 E STATESVILLE AVE STE 200
Mooresville, NC 28115
(704) 360-8486
✔ PECOS✔ Accepts MedicareSame address
Jacquelyn Mcginnis, PMHNP-BC
Nurse Practitioner
NPI 1750922779
400 E STATESVILLE AVE STE 200
Mooresville, NC 28115
(704) 360-8486
✔ PECOSSame address
Angela Micolucci, LCMHCS
Mental Health Counselor
NPI 1740434315
400 E STATESVILLE AVE STE 200
Mooresville, NC 28115
(704) 360-8486
✔ PECOSSame address
Aimee Culler
Clinical Social Worker
NPI 1215206214
919 N MAIN ST
Mooresville, NC 28115
(704) 591-4003
✔ PECOS0.7 mi
Jelena Mckeithan
Nurse Practitioner
NPI 1245985092
127 S MAIN ST
Davidson, NC 28036
(704) 892-7211
✔ PECOS✔ Accepts Medicare6.2 mi
Anita Vaughan, MSN,PMHNP-BC, FNP-BC
Nurse Practitioner
NPI 1710014022
284 EXECUTIVE PARK DR STE 100
Concord, NC 28025
(704) 939-1100
✔ PECOS✔ Accepts Medicare15 mi
Meredith Cullop, NP
Nurse Practitioner
NPI 1194312496
121 BROAD ST
Marion, VA 24354
(276) 781-5900
✔ PECOS95 mi
Marcy Speight, NP
Nurse Practitioner
NPI 1003946724
622 S MEMORIAL DR
Greenville, NC 27858
(570) 371-8303
✔ PECOS✔ Accepts Medicare192 mi

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

CLIA Laboratory Certificates CMS CLIA 3

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 34D2284217

Southern Family Medicine, Inc · High Point, NC
Active · expires Jun 19, 2027
CLIA Number34D2284217
Laboratory TypeIndependent
Certificate Effective DateJune 20, 2025
Certificate Expiration DateJune 19, 2027
Laboratory DirectorEdward Mogabgab
Laboratory Phone(704) 360-8486
Laboratory LocationSouthern Family Medicine, Inc160 Baker Rd, High Point, NC 27263
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 34D2183365

Southern Family Medicine, Inc · Mocksville, NC
Active · expires Jun 15, 2027
CLIA Number34D2183365
Laboratory TypePhysician Office
Certificate Effective DateJune 16, 2025
Certificate Expiration DateJune 15, 2027
Laboratory DirectorMr. Larry Allen
Laboratory Phone(336) 677-3900
Laboratory LocationSouthern Family Medicine, Inc121 Country Lane, Mocksville, NC 27028
CLIA data matches this NPI record on: Address Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 34D2121833

Southern Family Medicine · Mooresville, NC
Active · expires Nov 14, 2026
CLIA Number34D2121833
Laboratory TypePhysician Office
Certificate Effective DateNovember 15, 2024
Certificate Expiration DateNovember 14, 2026
Laboratory DirectorAngela J. Micolucci
Laboratory Phone(704) 360-8486
Laboratory LocationSouthern Family Medicine400 E Statesville Ave, Suite 200, Mooresville, NC 28115
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Southern Family Medicine, Inc.'s NPI number?

The NPI number for Southern Family Medicine, Inc. is 1881144590. It was assigned to this organization in the NPPES registry on October 5, 2016.

Where is Southern Family Medicine, Inc. located?

Southern Family Medicine, Inc. is located at 400 E Statesville Ave Ste 200, Mooresville, NC 28115. The listed phone number is (704) 360-8486.

What is Southern Family Medicine, Inc.'s specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Is Southern Family Medicine, Inc. enrolled in Medicare?

Yes. Southern Family Medicine, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Family Medicine, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 3 Medicare specialties reassign their Medicare billing to Southern Family Medicine, Inc.. 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 (6), Clinical Social Worker (1) and Mental Health Counselor (1). Of these, 3 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Southern Family Medicine, Inc. hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Southern Family Medicine, Inc. accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and AmeriHealth Caritas Next and 4 other insurers list Southern Family Medicine, Inc. 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 Southern Family Medicine, Inc. was last updated on January 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.