NPIMap

Individual provider Active NPI

Ted James Nifong, MD

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1063599587
Registry record updated Feb 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32817 Issued in NC
Practice address
5350 S Main St
Winston Salem, NC 27107-9174
Phone
(336) 784-0505
Fax
(336) 784-5031
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32817 NC Primary

Addresses

Primary practice location

5350 S Main St
Winston Salem, NC 27107-9174

Mailing address

5350 S Main St
Winston Salem, NC 27107-9174
Phone (336) 784-0505

Other identifiers 2

IdentifierTypeStateIssuer
1063599587OtherNCNPI
8962677MedicaidNC

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
I20040615000396 NC Practitioner - Family Practice 0244214690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wake Forest University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cedar Creek Family Medicine PLLCGroup PAC ID 4880869338, 2 clinicians

Practice addresses (Care Compare)

11492 Old US Hwy 52
Winston Salem, NC 27107-9497
Phone (336) 784-0505

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions32
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32817NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage Services, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ted.nifong.1@11229.direct.athenahealth.com

Organizations & group practices 2

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 10

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422748800000",
    "number": "1063599587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 S MAIN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079174",
            "telephone_number": "336-784-0505",
            "fax_number": "336-784-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 S MAIN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079174",
            "telephone_number": "336-784-0505",
            "fax_number": "336-784-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIFONG",
        "first_name": "TED",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2015-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "32817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1063599587",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8962677",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.