Wake Forest Health Network, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

WAKE FOREST HEALTH NETWORK, LLC

Practice address

1311 N Elm St Ste a
Greensboro, NC 27401-6306

Phone

(336) 378-9993

Fax

(336) 274-5884

NPI assigned

Mar 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Russell Mars Howerton

Title

Sr VP Network Phys & HS Cmo

Phone

(336) 716-1331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Atrium Health Wake Forest Baptist Shapiro Eye Care - Greensboro Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wake Forest Health Network LLC

  • Ophthalmology Physician
  • High Point, NC
  • NPI 1104959055

  4183538895

  Same PAC ID
• Wake Forest Health Network LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756

  4183538895

  Same PAC ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• North Carolina Baptist Hospital

  • Community/Retail Pharmacy
  • Winston Salem, NC
  • NPI 1881460855

  Member Of

  NPD member

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Jean Duffy, MD

  • Pediatrics Physician
  • Advance, NC
  • NPI 1801187059
  NPD
• Ailisa Hipp Smith, MD

  • Family Medicine Physician
  • Hickory, NC
  • NPI 1356479828
  NPD
• Leslie Rierson Smith, MD

  • Pediatrics Physician
  • Kernersville, NC
  • NPI 1356388540
  NPD
• Davis D Vu, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1508875972
  NPD
• Megan Ann Watson, D.O.

  • Family Medicine Physician
  • Thomasville, NC
  • NPI 1336591320
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1003114992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-716-1331",
            "fax_number": "336-716-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 N ELM ST STE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016306",
            "telephone_number": "336-378-9993",
            "fax_number": "336-274-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST HEALTH NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "HOWERTON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "MARS",
        "authorized_official_title_or_position": "SR VP NETWORK PHYS & HS CMO",
        "authorized_official_telephone_number": "336-716-1331"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917544",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atrium Health Wake Forest Baptist Shapiro Eye Care - Greensboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Forest Emergency Providers
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest Health Network, LLC
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences

• Ophthalmology Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Ophthalmology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.