Individual provider Active NPI

Thomas Ernest Gendrachi Jr., MD

  • Anesthesiology Physician
  • Winston Salem, NC
National Provider Identifier
1073596516
Registry record updated Mar 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
040459 Issued in CT
Practice address
145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone
(336) 768-3212
NPI assigned
Nov 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 040459 CT Primary

Addresses

Primary practice location

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983

Mailing address

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone (336) 768-3212

Other identifiers 1

IdentifierTypeStateIssuer
001404590MedicaidCT

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071207000584 NC Practitioner - Anesthesiology 1355306747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Triad Anesthesia PAGroup PAC ID 8426020025, 39 clinicians

Practice addresses (Care Compare)

145 Kimel Park Dr
Suite 120
Winston Salem, NC 27103-6983
Phone (336) 768-3212

3073 Trenwest Dr
Winston Salem, NC 27103-3207
Phone (336) 765-0960

3333 Silas Creek Pwky
Winston Salem, NC 27103-3013
Phone (336) 718-5000

654 Wishbone Farm Rd
Kernersville, NC 27284-7947
Phone (336) 564-4000

6915 Village Medical Cir
Clemmons, NC 27012-8002
Phone (336) 893-1000

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Triad Anesthesia, PA Anesthesiology CurrentSince Dec 10, 2007 Accepting new patients

Locations

7210 Village Medical Cir
Ste 235
Clemmons, NC 27012
Phone (336) 893-3100

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

1730 Kernersville Medical Pkwy
Ste 304
Kernersville, NC 27284
Phone (336) 515-7000

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

1999 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-5181

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

4605 Country Club Rd
Winston Salem, NC 27104
Phone (336) 310-5038

145 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-1770

2465 Hanestown Ln
Winston Salem, NC 27103
Phone (336) 201-0003

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

114 Charlois Blvd
Winston Salem, NC 27103

111 Hanestown Ct
#151
Winston Salem, NC 27103
Phone (919) 334-0150

Organizations & group practices 1

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 2

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551398400000",
    "number": "1073596516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-768-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-768-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENDRACHI",
        "first_name": "THOMAS",
        "middle_name": "ERNEST",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2019-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "040459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001404590",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.