Individual provider Active NPI

Nicholas Petit, M.D.

  • Emergency Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1174986517
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2019-01245 Issued in NC
Practice address
Wake Forest Baptist Medical Ctr
Medical Center Boulevard
Winston Salem, NC 27157-0001
Phone
(336) 716-4625
NPI assigned
Apr 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 2019-01245 NC Primary

Addresses

Primary practice location

Wake Forest Baptist Medical Ctr
Medical Center Boulevard
Winston Salem, NC 27157-0001

Mailing address

Wake Forest Baptist Medical Ctr
Medical Center Boulevard
Winston Salem, NC 27157-0001

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
I20190722003227 NC Practitioner - Emergency Medicine 3274826581 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

250 Hospital Dr
Lexington, NC 27292-6792
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Iredell Physician Network LLC CurrentSince Jun 26, 2021 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2019 Accepting new patients
Iredell Physician Network LLC CurrentSince Jun 26, 2021 Accepting new patients
Wake Forest Emergency Providers CurrentSince Jul 1, 2019 Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

250 Hospital Dr
Lexington, NC 27292
Phone (336) 238-4150

653 Bluefield Rd
Ste A
Mooresville, NC 28117
Phone (704) 360-6460

766 Hartness Rd
Statesville, NC 28677
Phone (704) 838-2182

1540 E Broad St
Statesville, NC 28625
Phone (704) 230-4382

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

Interoperability endpoints

  • Direct secure messaging: npetit2754006@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

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 6

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": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1174986517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WAKE FOREST BAPTIST MEDICAL CTR",
            "address_2": "MEDICAL CENTER BOULEVARD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WAKE FOREST BAPTIST MEDICAL CTR",
            "address_2": "MEDICAL CENTER BOULEVARD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETIT",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-02",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2019-01245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.