Individual provider Active NPI

Burnie Roy Little, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1083762603
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102074 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2255
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102074 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2255

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address blittle16142@direct.novanthealth.org

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100331000270 NC Practitioner - Physician Assistant 4880720614 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iredell Physician Network LLCGroup PAC ID 0749345007, 91 clinicians
Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

Statesville, NC 28677
Phone (704) 838-2182

105 Hanes Square Cir
Winston Salem, NC 27103-5514
Phone (336) 441-5569

1977 Cotton Grove Rd
Lexington, NC 27292-5721
Phone (336) 443-6041

2452 Fairlawn CT
Winston Salem, NC 27106-3884
Phone (336) 281-5965

2635 Lawndale Dr
Greensboro, NC 27408-4802
Phone (336) 867-4310

653 Bluefield Rd
Mooresville, NC 28117-9626

766 Hartness Rd
Suite B
Statesville, NC 28677-3479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iredell Physician Network LLC CurrentSince Aug 3, 2021 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince May 1, 2019 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince May 1, 2019 Accepting new patients
Iredell Physician Network LLC Past Accepting new patients
Carolina Medicorp Enterprises Inc Past Accepting new patients

Locations

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

653 Bluefield Rd
Ste A
Mooresville, NC 28117
Phone (704) 360-6460

766 Hartness Rd
Statesville, NC 28677
Phone (704) 838-2182

1540 E Broad St
Statesville, NC 28625
Phone (704) 230-4382

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

2452 Fairlawn Ct
Winston Salem, NC 27106
Phone (336) 281-5965

Interoperability endpoints

  • Direct secure messaging: blittle16142@direct.novanthealth.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1083762603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LITTLE",
        "first_name": "BURNIE",
        "middle_name": "ROY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "blittle16142@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "Medical Center Blvd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271570001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.