NPIMap

Individual provider Active NPI

Shumaila Khalil

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1013589175
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2024-00603 Issued in NC
Practice address
770 Highland Oaks Dr
Winston Salem, NC 27103-7105
Phone
(336) 765-5250
Fax
(336) 659-0953
NPI assigned
Jul 16, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 2024-00603 NC Primary

Addresses

Primary practice location

770 Highland Oaks Dr
Winston Salem, NC 27103-7105

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-1331

Other practice location 1

1431 SW 1st Ave # Bitzer7
Ocala, FL 34471-6500
Phone (352) 401-8311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241002001804 NC Practitioner - Internal Medicine 0042741902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

770 Highland Oaks Dr
Winston Salem, NC 27103-7105
Phone (336) 765-5250

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2024-00603NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network LLC Internal Medicine CurrentSince Sep 3, 2024 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Sep 3, 2024 Accepting new patients
Cornerstone Health Care LLC Past Accepting new patients
Wake Forest Health Network LLC Past Accepting new patients

Locations

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

770 Highland Oaks Dr
Winston Salem, NC 27103
Phone (336) 718-6700

770 Highland Oaks Dr
#110
Winston Salem, NC 27103

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

  • Direct secure messaging: skhalil2962044@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1013589175",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 HIGHLAND OAKS DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271037105",
            "telephone_number": "336-765-5250",
            "fax_number": "336-659-0953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1431 SW 1st Ave # Bitzer7",
            "address_purpose": "LOCATION",
            "city": "Ocala",
            "state": "FL",
            "postal_code": "344716500",
            "country_code": "US",
            "telephone_number": "352-401-8311",
            "fax_number": "352-401-8313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHALIL",
        "first_name": "SHUMAILA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2024-00603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.