NPIMap

Organization Active NPI

Forsyth Memorial Hospital, Inc

  • Infectious Disease Physician
  • Kernersville, NC
National Provider Identifier
1083666556
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
FORSYTH MEMORIAL HOSPITAL, INC
Doing business as
Novant Health Woud Care
Novant Health Wound Care
Practice address
1710 Kernersville Medical Pkwy Ste 220
Kernersville, NC 27284-7156
Phone
(336) 564-4360
Fax
(336) 564-4947
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

1710 Kernersville Medical Pkwy Ste 220
Kernersville, NC 27284-7156

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-1440

Other practice location 1

250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone (336) 718-1440

Other identifiers 1

IdentifierTypeStateIssuer
7000496MedicaidNC

Other names 2

  • Novant Health Woud Care Doing business as
  • Novant Health Wound Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001702 NC Part B Supplier - Clinic/Group Practice 9537071790 Receives reassigned benefits from 1,329 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

1901 S Hawthorne Rd
Ste 220
Winston Salem, NC 27103
Phone (336) 718-6777

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1083666556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-718-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KERNERSVILLE MEDICAL PKWY STE 220",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847156",
            "telephone_number": "336-564-4360",
            "fax_number": "336-564-4947"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1440",
            "fax_number": "336-718-1173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FORSYTH MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000496",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Woud Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Wound Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Wound Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.