Wintergreen Medical Center, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

141455 Issued in NC

Legal business name

WINTERGREEN MEDICAL CENTER, PLLC

Practice address

324A Beacon Dr
Winterville, NC 28590-7956

Phone

(252) 551-5595

Fax

(252) 321-7762

NPI assigned

Jul 20, 2007

Last updated

Feb 18, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

WINTERGREEN MEDICAL CENTER, PLLCAs reported in NPPES

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

Authorized official

Name

Leland Calvin Ellis, PA-CNPI 1386749695

Title

Owner

Phone

(252) 551-5595

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Part of

Wintergreen Med Ctr PLLC

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leland Calvin Ellis Jr., PA-C

  • Medical Physician Assistant
  • Winterville, NC
  • NPI 1386749695
  Medicare reassignment Care Compare group Authorized official
• Nadiah Mahmoud, FNP

  • Family Nurse Practitioner
  • Winterville, NC
  • NPI 1134900236
  Medicare reassignment Care Compare group NPD
• Carol Josephine Gates, DNP, FNP-BC

  • Family Nurse Practitioner
  • Greenville, NC
  • NPI 1215419825
  Medicare reassignment NPD
• Robert Barwick, PA

  • Physician Assistant
  • Goldsboro, NC
  • NPI 1063878064
  Medicare reassignment
• Leslie C Sexton, PA-C

  • Medical Physician Assistant
  • Winterville, NC
  • NPI 1811254436
  Medicare reassignment
• Marshall Craig Simpson, M.D.

  • Family Medicine Physician
  • Winterville, NC
  • NPI 1841366291
  Medicare reassignment

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1225238009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324-A BEACON DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285907956",
            "telephone_number": "252-551-5595",
            "fax_number": "252-321-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324A BEACON DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285907956",
            "telephone_number": "252-551-5595",
            "fax_number": "252-321-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINTERGREEN MEDICAL CENTER, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINTERGREEN MEDICAL CENTER, PLLC",
        "enumeration_date": "2007-07-20",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LELAND",
        "authorized_official_middle_name": "CALVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-551-5595",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "141455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8976432",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William S. Harvey, III DDS4 (Beacon Dental)
• Gabrielle Alexis Williams, LRT, CTRS
• Latina Gay Williams, LCAS LCMHCS CCS
• Shaniqua Nicole Williams
• Toddra Maye Williams, MS, LCMHC, LCAS
• Winterville Rescue & EMS, Inc.
• William Chadwick Wood, M.D.
• Danielle Woodard, PHARMD
• Christopher Lee Woods
• Irene Zakher

• Clinic/Center in Winterville, NC
• Providers in Winterville, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.