Individual provider Active NPI

Kiran Mullur, MD

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1164982880
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101288534 Issued in VA
Practice address
1 Medical Center Boulevard
Winston Salem, NC 27157-0001
Phone
(336) 716-4479
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 0101288534 VA
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 0101288534 VA Primary

Addresses

Primary practice location

1 Medical Center Boulevard
Winston Salem, NC 27157-0001

Mailing address

1 Jonathan Ave
Millbury, MA 01527-3950
Phone (508) 450-1534

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
I20240329001574 NC Practitioner - Family Practice 2264769181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Massachusetts Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jul 5, 2023 Accepting new patients

Locations

2311 Lewisville Clemmons Rd
Clemmons, NC 27012
Phone (336) 713-0400

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

1920 W 1st St
Winston Salem, NC 27104
Phone (336) 716-4479

Interoperability endpoints

  • Direct secure messaging: kmullur2754460@carolinashealthcaresystem.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1164982880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JONATHAN AVE",
            "city": "MILLBURY",
            "state": "MA",
            "postal_code": "015273950",
            "telephone_number": "508-450-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BOULEVARD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLUR",
        "first_name": "KIRAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "VA",
            "license": "0101288534",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101288534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.