Individual provider Active NPI

Kenneth E Nelson, MD

  • Anesthesiology Physician
  • Winston Salem, NC
National Provider Identifier
1114902244
Registry record updated Sep 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
9600657 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2255
NPI assigned
Dec 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 9600657 NC
Anesthesiology Physician 207L00000X 9600657 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

PO Box 344
Winston Salem, NC 27102-0344
Phone (336) 716-2255

Other identifiers 7

IdentifierTypeStateIssuer
891032UMedicaidNC
3810001343MedicaidWV
72411OtherNCMEDCOST
5124538OtherAETNA
5716047MedicaidVA
1032UOtherNCBCBS
19627OtherNCPARTNERS

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100316001028 NC Practitioner - Anesthesiology 7911032958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Texas Medical School at Houston, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Triad Anesthesia PAGroup PAC ID 8426020025, 39 clinicians

Practice addresses (Care Compare)

145 Kimel Park Dr
Suite 120
Winston Salem, NC 27103-6983
Phone (336) 768-3212

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9600657NCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Triad Anesthesia, PA Anesthesiology CurrentSince Dec 1, 2019 Accepting new patients

Locations

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

7210 Village Medical Cir
Ste 235
Clemmons, NC 27012
Phone (336) 893-3100

1730 Kernersville Medical Pkwy
Ste 304
Kernersville, NC 27284
Phone (336) 515-7000

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

4605 Country Club Rd
Winston Salem, NC 27104
Phone (336) 310-5038

145 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-1770

2465 Hanestown Ln
Winston Salem, NC 27103
Phone (336) 201-0003

1999 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-5181

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

114 Charlois Blvd
Winston Salem, NC 27103

111 Hanestown Ct
#151
Winston Salem, NC 27103
Phone (919) 334-0150

Interoperability endpoints

  • Direct secure messaging: knelson129722@direct.novanthealth.org

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504828800000",
    "number": "1114902244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "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": "NELSON",
        "first_name": "KENNETH",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2017-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NC",
            "license": "9600657",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "9600657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891032U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001343",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "72411",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5124538",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5716047",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1032U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "19627",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.