NPIMap

Organization Active NPI

Moses Cone Affiliated Physicians, Inc.

Doing business as Premier Pediatrics of Eden

  • Pediatrics Physician
  • Eden, NC
National Provider Identifier
1114228475
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MOSES CONE AFFILIATED PHYSICIANS, INC.
Doing business as
Premier Pediatrics of Eden
Practice address
509 S Van Buren Rd
Suite B
Eden, NC 27288-5082
Phone
(336) 627-5437
Fax
(336) 627-1681
NPI assigned
Nov 3, 2010
Last updated
Nov 29, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
THE MOSES H. CONE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Authorized official

Name
Mr. Kenneth K Boggs
Title
Cfo/Treasurer
Phone
(336) 832-8005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

509 S Van Buren Rd
Suite B
Eden, NC 27288-5082

Mailing address

509 S Van Buren Rd
Suite B
Eden, NC 27288-5082
Phone (336) 627-5437

Other identifiers 1

IdentifierTypeStateIssuer
5916799MedicaidNC

Other names 1

  • Premier Pediatrics of Eden Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2015283Premier Pediatrics of Eden509 South Van Buren Road, Suite B, Eden, NC 27288Certificate of waiverOct 24, 2026

National Provider Directory

National Provider Directory
Tax ID family
Moses Cone Affiliated Physicians12 organizations share this tax ID, including this one
Part of
Moses Cone Mem Hosp

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

600 W Salisbury St
Ste D
Asheboro, NC 27203
Phone (336) 375-6990

110 S Park Ter
#A
Eden, NC 27288
Phone (336) 627-3878

509 S Van Buren Rd
Ste B
Eden, NC 27288
Phone (336) 627-5437

100 E Northwood St
Ste A
Greensboro, NC 27401
Phone (336) 230-2434

1617 NC Highway 66 S
Kernersville, NC 27284

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1114228475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S VAN BUREN RD",
            "address_2": "SUITE B",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885082",
            "telephone_number": "336-627-5437",
            "fax_number": "336-627-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 S VAN BUREN RD",
            "address_2": "SUITE B",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885082",
            "telephone_number": "336-627-5437",
            "fax_number": "336-627-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES CONE AFFILIATED PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MOSES H. CONE MEMORIAL HOSPITAL",
        "enumeration_date": "2010-11-03",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO/TREASURER",
        "authorized_official_telephone_number": "336-832-8005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916799",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pediatrics of Eden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eden, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.