Tesfaye Demissie Fanta, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9700943 Issued in NC

Practice address

910 West Harrison Street
Reidsville, NC 27320

Phone

(336) 342-9564

Fax

(336) 349-9723

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Internal Medicine

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Suncrest Home Health Home health agency, Greensboro, NC, CCN 347120
• Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• KND Development 59 , LLC

  • Hospitalist Physician
  • Greensboro, NC
  • NPI 1619206133
  Medicare reassignment NPD
• Tesfaye D Fanta MD PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Reidsville, NC
  • NPI 1033489216
  NPD Authorized official
• KND Development 59, LLC

  dba Specialty Hospitals Broken Arrow

  • Hospitalist Physician
  • Broken Arrow, OK
  • NPI 1922950823
  NPD
• Rmsa Inc Health Center

  • Geriatric Medicine (Family Medicine) Physician
  • Reidsville, NC
  • NPI 1679525380
  NPD (past)
• Rockingham Urology Assoc

  • Urology Physician
  • Reidsville, NC
  • NPI 1922083146
  NPD (past)
• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  NPD (past)

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

• Innovative Senior Care Home Health of High Point LLC

  dba SunCrest Home Health

  • Home Health Agency
  • Greensboro, NC
  • NPI 1558637504
  Care Compare affiliation
• The Moses H. Cone Memorial Hospital Operating Corporation

  • General Acute Care Hospital
  • Greensboro, NC
  • NPI 1477591055
  Care Compare affiliation

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1174557128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 WEST HARRISON STREET",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "27320",
            "telephone_number": "336-342-9564",
            "fax_number": "336-349-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 WEST HARRISON STREET",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "27320",
            "telephone_number": "336-342-9564",
            "fax_number": "336-349-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTA",
        "first_name": "TESFAYE",
        "middle_name": "DEMISSIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9700943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891066A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roy O Fagan III, MD
• Cassondra Danielle Faircloth, MA, LCMHCA
• Faith & Love Connection Center
• Faithworks Assisted Living
• Family Tree OB GYN, PA
• Dorris A. Farmer, COF, CFM, CFTS
• Karlene Chanell Figueroa
• Marianna Rose Fittante
• Robin E. Floyd, FNP
• Toya Foster

• Internal Medicine Physician in Reidsville, NC
• Providers in Reidsville, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.