Michael Scott Blau, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103449 Issued in NC

Practice address

190 Kimel Park Dr Ste 140
Winston Salem, NC 27103-6946

Phone

(336) 277-2225

Fax

(336) 277-2231

NPI assigned

Feb 14, 2006

Last updated

Nov 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment NPD
• Neurosurgical Associates of the

  • Neurological Surgery Physician
  • Winston Salem, NC
  • NPI 1003917725
  NPD (past)
• NH-CL Clinics, LLC

  dba CoreLife Novant Health

  • Family Medicine Physician
  • Kernersville, NC
  • NPI 1487276499
  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1093789414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-277-2225",
            "fax_number": "336-277-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 140",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-277-2225",
            "fax_number": "336-277-2231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5826 Samet Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272653661",
            "country_code": "US",
            "telephone_number": "336-905-6300",
            "fax_number": "336-716-9258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAU",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102570",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Anne Blankenship, FNP-C
• Juliana Blanton, MA
• Katherine Caroline Blanton
• Erica Kristen Blasic, LPC
• Tina Maria Blaszczyk, LCSW-A
• Grant Blaylock, MD
• Kimberlee Banks Blaylock, P.A.-C
• Eugene Bleecker, MD
• Anthony Bleyer, MD
• Brenda Blittersdorf

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.