Individual provider Active NPI

Karen Annette Gilliam, NP

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1205807302
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
01386 Issued in NC
Practice address
50 Miller St Ste G
Winston Salem, NC 27104-4206
Phone
(336) 718-1000
Fax
(336) 718-1065
NPI assigned
Jan 28, 2006
Last updated
Jan 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 01386 NC Primary

Addresses

Primary practice location

50 Miller St Ste G
Winston Salem, NC 27104-4206

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-1000

Other practice location 1

250 Charlois Blvd
DBA Winston-Salem Healthcare
Winston Salem, NC 27103-1508
Phone (336) 718-1000

Other identifiers 1

IdentifierTypeStateIssuer
7005444MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgilliam4622@direct.novanthealth.org

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070912000896 NC Practitioner - Nurse Practitioner 5395838981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone (336) 718-1440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
01386NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince May 3, 2009 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince May 3, 2009 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

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

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

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

175 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 718-1006

250 Charlois Blvd
Winston Salem, NC 27103
Phone (336) 718-1000

50 Miller St
Ste G
Winston Salem, NC 27104
Phone (336) 718-1000

Interoperability endpoints

  • Direct secure messaging: kgilliam4622@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1205807302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MILLER ST STE G",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044206",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Charlois Blvd",
            "address_2": "DBA Winston-Salem Healthcare",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "KAREN",
        "middle_name": "ANNETTE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-28",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "01386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005444",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgilliam4622@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "250 Charlois Blvd",
            "address_2": "DBA Winston-Salem Healthcare",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271031508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.