Samuel Sparrow Pendergraft, PHD, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-08261 Issued in NC

Practice address

1900 W Park Dr Ste C
North Wilkesboro, NC 28659-3563

Phone

(336) 903-6920

Fax

(336) 903-6921

NPI assigned

Sep 25, 2018

Last updated

Feb 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wilkes Regional Medical Center Hospital, North Wilkesboro, NC, CCN 340064
• North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• North Carolina Baptist Hospital

  • Psychiatric Hospital Unit
  • Winston Salem, NC
  • NPI 1063480531
  Care Compare affiliation
• North Carolina Baptist Hospital

  • Rehabilitation Hospital Unit
  • Winston Salem, NC
  • NPI 1114995677
  Care Compare affiliation
• North Carolina Baptist Hospital

  dba Wake Forest Baptist Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1144211301
  Care Compare affiliation
• North Carolina Baptist Hospital

  dba Wake Forest Baptist Medical Center

  • Clinical Medical Laboratory
  • Winston Salem, NC
  • NPI 1609162098

  Hospital

  Care Compare affiliation
• North Carolina Baptist Hospital

  dba Winston East Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Winston Salem, NC
  • NPI 1912179219

  Hospital

  Care Compare affiliation
• WRMC Hospital Operating Corporation

  dba Wilkes Regional Medical Center

  • General Acute Care Hospital
  • North Wilkesboro, NC
  • NPI 1881614071
  Care Compare affiliation

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1013492180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W PARK DR STE C",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593563",
            "telephone_number": "336-903-6920",
            "fax_number": "336-903-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W PARK DR STE C",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593563",
            "telephone_number": "336-903-6920",
            "fax_number": "336-903-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAFT",
        "first_name": "SAMUEL",
        "middle_name": "SPARROW",
        "name_prefix": "Dr.",
        "credential": "PHD, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-25",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Cardwell Ortiz, OTR/L
• Raja Rajeswara Rao Paladugu, M.D.
• Tonya Louise Palmer, FNP
• Paragon Outpatient Rehabilitation Services, LLC (Synchrony Rehab)
• Danny J Payne, OD
• Joel Laron Perkins, BA/QP
• Sarah Peters, MD
• Matthew Pham
• Phillip Marvin Brame DDS Ms PA
• Charles Henry Phillips III, P.A.

• Physician Assistant in North Wilkesboro, NC
• Providers in North Wilkesboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.