Individual provider Active NPI

Jordan Elijah Rotstein Tannenbaum, MD

  • Cardiovascular Disease Physician
  • Winston Salem, NC
National Provider Identifier
1144727645
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2021-02064 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-1900
Phone
(336) 716-6674
NPI assigned
Apr 11, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 2021-02064 NC Primary
Internal Medicine Physician 207R00000X 2021-02064 NC

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-1900

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-6674

Other practice location 1

625 19th St S
Birmingham, AL 35233-1900
Phone (205) 934-9666

Other practice location 2

186 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone (336) 277-2000

Other practice location 3

694 Riverside Dr
Mount Airy, NC 27030-3117
Phone (336) 719-7892

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
I20220427000481 NC Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 8921354846 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1226 Eastchester Dr
Suite 100
High Point, NC 27265-3116
Phone (336) 481-8540

186 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone (336) 277-2000

3515 W Market St
Suite 110
Greensboro, NC 27403-4439
Phone (336) 660-5220

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Northern Regional Hospital Hospital, Mount Airy, NC, CCN 340003
  • Twin County Regional Hospital Hospital, Galax, VA, CCN 490115
  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Sep 12, 2022 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation CurrentSince Jul 30, 2023 Accepting new patients
Novant Health Thomasville Medical Center, LLC CurrentSince Jul 29, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
The Presbyterian Hospital CurrentSince Feb 27, 2025 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Novant Health Thomasville Medical Center LLC CurrentSince Jul 29, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. Cardiovascular Disease CurrentSince Sep 12, 2022 Accepting new patients
Forsyth Memorial Hospital Inc Cardiovascular Disease CurrentSince Sep 12, 2022 Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation Internal Medicine Current Accepting new patients
Novant Health Medical Group, LLC Cardiovascular Disease CurrentSince Jul 7, 2024 Accepting new patients
The Presbyterian Hospital Internal Medicine CurrentSince Feb 27, 2025 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
The Presbyterian Hospital Internal Medicine Current Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation Internal Medicine CurrentSince Jul 30, 2023 Accepting new patients
Novant Health Medical Group, LLC Cardiovascular Disease CurrentSince Sep 12, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

125 Queens Rd
Charlotte, NC 28204
Phone (980) 302-6380

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

125 Baldwin Ave
Ste 200
Charlotte, NC 28204
Phone (704) 384-5043

7114 Village Medical Cir
Clemmons, NC 27012
Phone (336) 893-2440

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

189 Samaritans Ridge Rd
Elkin, NC 28621
Phone (336) 526-3003

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

1126 N Church St
Ste 300
Greensboro, NC 27401
Phone (336) 547-1700

2400 W Friendly Ave
Greensboro, NC 27403
Phone (336) 832-1100

509 N Elam Ave
Fl 3
Greensboro, NC 27403
Phone (336) 832-1970

3515 W Market St
Ste 110
Greensboro, NC 27403
Phone (336) 299-0099

1226 Eastchester Dr
#100
High Point, NC 27265
Phone (336) 481-8540

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

1710 Kernersville Medical Pkwy
Ste 205
Kernersville, NC 27284
Phone (336) 983-4500

144 Forest Hill Rd
Ste 144146
Lexington, NC 27295
Phone (336) 481-1730

694 Riverside Dr
Mount Airy, NC 27030
Phone (336) 719-7892

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

211 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-1191

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

725 Highland Oaks Dr
Ste 200
Winston Salem, NC 27103
Phone (336) 277-2620

2025 Frontis Plaza Blvd
Ste 100
Winston Salem, NC 27103
Phone (336) 718-6199

186 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 277-2000

185 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 277-2000

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

Interoperability endpoints

  • Direct secure messaging: jtannenbaum1080093@direct.novanthealth.org

Organizations & group practices 17

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

View all 17

Hospital & facility affiliations 9

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1144727645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-6674"
        },
        {
            "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": "271571900",
            "telephone_number": "336-716-6674"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 19th St S",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352331900",
            "country_code": "US",
            "telephone_number": "205-934-9666",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "186 Kimel Park Dr",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271036946",
            "country_code": "US",
            "telephone_number": "336-277-2000",
            "fax_number": "336-277-2050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "694 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Mount Airy",
            "state": "NC",
            "postal_code": "270303117",
            "country_code": "US",
            "telephone_number": "336-719-7892",
            "fax_number": "336-719-7898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "JORDAN",
        "middle_name": "ELIJAH ROTSTEIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "2021-02064",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2021-02064",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.