NPIMap

Organization Active NPI

Wake Forest Health Network LLC

Doing business as Atrium Health Wake Forest Baptist Pediatrics - Ford Simpson Lively & R

  • Pediatrics Physician
  • Winston Salem, NC
National Provider Identifier
1063647394
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAKE FOREST HEALTH NETWORK LLC
Doing business as
Atrium Health Wake Forest Baptist Pediatrics - Ford Simpson Lively & R
Practice address
2933 Maplewood Ave
Winston Salem, NC 27103-4009
Phone
(336) 794-3380
Fax
(336) 794-3378
NPI assigned
May 15, 2009
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

Name
Craig Michael Greven, MD
Title
Sr VP Clinical Operations
Phone
(336) 716-1331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2933 Maplewood Ave
Winston Salem, NC 27103-4009

Mailing address

2933 Maplewood Ave Ste 1
Winston Salem, NC 27103-4001
Phone (336) 794-3380

Other identifiers 3

IdentifierTypeStateIssuer
5950113MedicaidNC
5909124MedicaidNC
5950112MedicaidNC

Other names 1

  • Atrium Health Wake Forest Baptist Pediatrics - Ford Simpson Lively & R Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000868 NC Part B Supplier - Clinic/Group Practice 4183538895 Receives reassigned benefits from 690 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: High Point, NC; Jefferson, NC; Jonesville, NC; Kernersville, NC; Summerfield, NC; Thomasville, NC; Winston Salem, NC; Archdale, NC…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0964035Ah Wake Forest Baptist Pediatrics- Ford2933 Maplewood Ave, Winston-Salem, NC 27103Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cornerstone Health Care LLC55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1063647394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2933 MAPLEWOOD AVE STE 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034001",
            "telephone_number": "336-794-3380",
            "fax_number": "336-794-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2933 MAPLEWOOD AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034009",
            "telephone_number": "336-794-3380",
            "fax_number": "336-794-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST HEALTH NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-15",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "GREVEN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SR VP CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "336-716-1331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950113",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909124",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950112",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atrium Health Wake Forest Baptist Pediatrics - Ford Simpson Lively & R",
            "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 Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.