NPIMap

Organization Active NPI

Medical Park Hospital LLC

  • Specialist
  • Winston-Salem, NC
National Provider Identifier
1003867516
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MEDICAL PARK HOSPITAL LLC
Practice address
1950 S Hawthorne Rd
Winston-Salem, NC 27103-3912
Phone
(336) 718-0600
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Authorized official

Name
Alisha Hutchens
Title
Pres & Coo
Phone
(336) 995-8885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1950 S Hawthorne Rd
Winston-Salem, NC 27103-3912

Mailing address

2085 Frontis Plaza Blvd
Winston-Salem, NC 27103-5614
Phone (336) 277-7226

Other identifiers 1

IdentifierTypeStateIssuer
8907609MedicaidNC

Other names 1

  • Medical Park Professional Fee Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000968 NC Part B Supplier - Clinic/Group Practice 4880595958 Receives reassigned benefits from 572 practitioners
Practice locations: Winston Salem, NC

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

1950 S Hawthorne Rd
Ste 100
Winston Salem, NC 27103

Practitioners & affiliated clinicians

Practitioners 578

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

View all 578

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1003867516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271035614",
            "telephone_number": "336-277-7226",
            "fax_number": "336-277-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 S HAWTHORNE RD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271033912",
            "telephone_number": "336-718-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PARK HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "HUTCHENS",
        "authorized_official_first_name": "ALISHA",
        "authorized_official_title_or_position": "PRES & COO",
        "authorized_official_telephone_number": "336-995-8885"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8907609",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Park Professional Fee",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Park Professional Fee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston-Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.