Active NPI
Samuel Craig Kirby, MD
- Dermatology Physician
- High Point, NC
National Provider Identifier
1124022652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 30188
- Practice address
- 404 Westwood Ave
Ste 107
High Point, NC 27262-4316 - Phone
- (336) 887-3195
- Fax
- (336) 887-3194
- NPI assigned
- Jun 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 30188 | NC | Primary |
Addresses
Primary practice location
404 Westwood Ave
Ste 107
High Point, NC 27262-4316
Mailing address
404 Westwood Ave
Ste 107
High Point, NC 27262-4316
Phone (336) 887-3195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8949386 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30188 | NC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262908800000",
"number": "1124022652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 WESTWOOD AVE",
"address_2": "STE 107",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624316",
"telephone_number": "336-887-3195",
"fax_number": "336-887-3194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 WESTWOOD AVE",
"address_2": "STE 107",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624316",
"telephone_number": "336-887-3195",
"fax_number": "336-887-3194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "SAMUEL",
"middle_name": "CRAIG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2010-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NC",
"license": "30188",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8949386",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.