NPIMap

Organization Active NPI

Greensboro Family Medicine PA

  • Internal Medicine Physician
  • Greensboro, NC
National Provider Identifier
1104124155
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
200600668 Issued in NC
Legal business name
GREENSBORO FAMILY MEDICINE PA
Practice address
104 W Northwood St
Suite a
Greensboro, NC 27401-1326
Phone
(336) 790-0519
Fax
(336) 691-8977
NPI assigned
Feb 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

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

Authorized official

Name
Mr. John Joseph Dewar Sr., PA-C
Title
Physician Assistant
Phone
(336) 790-0519

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 200600668 NC Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 001000092 NC

Addresses

Primary practice location

104 W Northwood St
Suite a
Greensboro, NC 27401-1326

Mailing address

104 W Northwood St
Suite a
Greensboro, NC 27401-1326
Phone (336) 790-0519

Other identifiers 3

IdentifierTypeStateIssuer
87726OtherNCUNITED HEALTH CARE
142U7OtherNCBCBSNC
5907415MedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1104124155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W NORTHWOOD ST",
            "address_2": "SUITE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011326",
            "telephone_number": "336-790-0519",
            "fax_number": "336-691-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W NORTHWOOD ST",
            "address_2": "SUITE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011326",
            "telephone_number": "336-790-0519",
            "fax_number": "336-691-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENSBORO FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "DEWAR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "336-790-0519",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200600668",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001000092",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "87726",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "142U7",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907415",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; 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.