Individual provider Active NPI

Sigmund Ian Tannenbaum, MD

  • Urology Physician
  • Greensboro, NC
National Provider Identifier
1225024540
Registry record updated Feb 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
20977 Issued in NC
Practice address
509 N Elam Ave FL 2
Greensboro, NC 27403-1157
Phone
(336) 274-1114
Fax
(336) 232-5325
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 20977 NC Primary

Addresses

Primary practice location

509 N Elam Ave FL 2
Greensboro, NC 27403-1157

Mailing address

509 N Elam Ave FL 2
Greensboro, NC 27403-1157
Phone (336) 274-1114

Other identifiers 2

IdentifierTypeStateIssuer
81526OtherNCBLUE CROSS BLUE SHIELD
8981526MedicaidNC

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
I20040714001310 NC Practitioner - Urology 3476532425 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Duke University School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3903 N Elm St
Greensboro, NC 27455-2594
Phone (336) 713-4944

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Specialists of the Carolinas PLLC Urology CurrentSince Sep 1, 1999 Accepting new patients
Wake Forest University Health Sciences CurrentSince Oct 16, 2021 Accepting new patients

Locations

3903 N Elm St
Greensboro, NC 27455
Phone (336) 716-4131

509 N Elam Ave
Fl 2
Greensboro, NC 27403
Phone (336) 274-1114

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

Interoperability endpoints

  • Direct secure messaging: stannenbaum2754019@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

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 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": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297382400000",
    "number": "1225024540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 N ELAM AVE FL 2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031157",
            "telephone_number": "336-274-1114",
            "fax_number": "336-232-5325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N ELAM AVE FL 2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031157",
            "telephone_number": "336-274-1114",
            "fax_number": "336-232-5325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "SIGMUND",
        "middle_name": "IAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2011-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "20977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "81526",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8981526",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.