NPIMap

Organization Active NPI

Wake Forest University Baptist Medical Center Community Physicians

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1073506358
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Practice address
1930 North Peace Haven Rd
Winston Salem, NC 27106-4817
Phone
(336) 760-5400
Fax
(336) 760-0254
NPI assigned
Aug 23, 2005
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Authorized official

Name
Mr. Lewis S Thorp III
Title
President Ceo
Phone
(336) 721-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X NC Primary

Addresses

Primary practice location

1930 North Peace Haven Rd
Winston Salem, NC 27106-4817

Mailing address

1930 North Peace Haven Rd
Winston Salem, NC 27106-4817
Phone (336) 760-5400

Other identifiers 2

IdentifierTypeStateIssuer
890237TMedicaidNC
2317728FOtherNCMEDICARE GROUP NUMBER

Other names 1

  • Peace Haven Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Part of
Peace Haven Urgent Care

Locations

1930 N Peace Haven Rd
Winston Salem, NC 27106
Phone (336) 760-5400

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1073506358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 NORTH PEACE HAVEN RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271064817",
            "telephone_number": "336-760-5400",
            "fax_number": "336-760-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 NORTH PEACE HAVEN RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271064817",
            "telephone_number": "336-760-5400",
            "fax_number": "336-760-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "enumeration_date": "2005-08-23",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "THORP",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "336-721-3900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890237T",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peace Haven Internal Medicine",
            "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 Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.