Active NPI
Wake Forest Ambulatory Ventures, LLC
- Ambulatory Surgical Clinic/Center
- Winston Salem, NC
National Provider Identifier
1225568884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- Legal business name
- WAKE FOREST AMBULATORY VENTURES, LLC
- Practice address
- 6441 Kinnamon CT
Winston-Salem, NC 27103 - Phone
- (833) 283-5487
- NPI assigned
- Jun 15, 2017
- Last updated
- Sep 29, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Desiree Dunston
- Title
- Administrator
- Phone
- (336) 716-3335
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | NU | Primary |
Addresses
Primary practice location
6441 Kinnamon CT
Winston-Salem, NC 27103
Mailing address
6441 Kinnamon CT
Winston Salem, NC 27103-9819
Phone (833) 283-5487
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180409001721 | NC | Part B Supplier - Ambulatory Surgical Center | 3779846571 | Practice locations: Winston Salem, NC |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Atrium Health Wake Forest Baptist Surgery Center Premier
- Ambulatory Surgical Clinic/Center
- High Point, NC
- NPI 1164215570
3779846571
-
dba Atrium Health Wake Forest Baptist Surgery Center High Point
- Ambulatory Surgical Clinic/Center
- High Point, NC
- NPI 1245023654
3779846571
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Wake Forest Joint Ventures LLC
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Wake Forest Ambulatory Ventures LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Atrium Health Wake Forest Baptist Surgery Center Premier
- Ambulatory Surgical Clinic/Center
- High Point, NC
- NPI 1164215570
-
dba Atrium Health Wake Forest Baptist Surgery Center High Point
- Ambulatory Surgical Clinic/Center
- High Point, NC
- NPI 1245023654
-
- Ambulatory Surgical Clinic/Center
- Greensboro, NC
- NPI 1992668008
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- Ophthalmology Physician
- Greensboro, NC
- NPI 1225139249
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497484800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1759104000000",
"number": "1225568884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6441 KINNAMON CT",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271039819",
"telephone_number": "833-283-5487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6441 KINNAMON CT",
"city": "WINSTON-SALEM",
"state": "NC",
"postal_code": "27103",
"telephone_number": "833-283-5487"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAKE FOREST AMBULATORY VENTURES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-15",
"last_updated": "2025-09-29",
"certification_date": "2025-09-29",
"status": "A",
"authorized_official_last_name": "DUNSTON",
"authorized_official_first_name": "DESIREE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "336-716-3335"
},
"taxonomies": [
{
"code": "261QA1903X",
"taxonomy_group": "",
"desc": "Clinic/Center, Ambulatory Surgical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "64 S Price Rd Ste B",
"city": "Brownsville",
"state": "TX",
"country_code": "US",
"postal_code": "785212459",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Winston Salem, NC
- Gwendolyn Field Wagoner, M.D.
- Jennifer Kay Wagstaff
- Ali Saeed Wahla, M.D
- George Sidney Waits IV, M.D.
- Wake Air Care LLC
- Wake Forest Baptist Health
- Wake Forest Baptist Health Care at Home, LLC (Atrium Health Wake Forest Baptist - Care at Home)
- Wake Forest Baptist Health Center
- Wake Forest Baptist Imaging, LLC (Atrium Health Wake Forest Baptist Imaging)
- Wake Forest Baptist Medical Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.