NPIMap

Organization Active NPI

Wake Forest University Health Sciences

  • Clinic/Center
  • Statesville, NC
National Provider Identifier
1245757665
Registry record updated Aug 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WAKE FOREST UNIVERSITY HEALTH SCIENCES
Practice address
557 Brookdale Dr
Statesville, NC 28677-4107
Phone
(336) 716-2255
NPI assigned
Aug 25, 2017
Last updated
Aug 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2017

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

Authorized official

Name
Kevin Paul High, MDNPI 1144205428
Title
Evp Health System Affairs
Phone
(336) 716-4724

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

557 Brookdale Dr
Statesville, NC 28677-4107

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000436 NC Part B Supplier - Clinic/Group Practice 4486564952 Receives reassigned benefits from 3,530 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

306 Westwood Ave
Ste 401
High Point, NC 27262
Phone (336) 885-6168

5826 Samet Dr
Ste 101
High Point, NC 27265
Phone (336) 878-6540

13 Medical Park Dr
Lexington, NC 27292
Phone (336) 236-4000

1900 W Park Dr
Ste B
North Wilkesboro, NC 28659
Phone (336) 903-6840

4614 Country Club Rd
Winston Salem, NC 27104
Phone (336) 716-3787

4618 Country Club Rd
Winston Salem, NC 27104
Phone (336) 716-2768

791 Jonestown Rd
Winston Salem, NC 27103
Phone (336) 716-5993

Practitioners & affiliated clinicians

Practitioners 249

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.

View all 249

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1245757665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774107",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY HEALTH SCIENCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "HIGH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "EVP HEALTH SYSTEM AFFAIRS",
        "authorized_official_telephone_number": "336-716-4724",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; 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.