NPIMap

Organization Active NPI

Bethany Medical Center

  • Internal Medicine Physician
  • High Point, NC
National Provider Identifier
1255880571
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BETHANY MEDICAL CENTER
Practice address
1580 Skeet Club Rd
High Point, NC 27265-9530
Phone
(336) 883-0029
Fax
(336) 899-2176
NPI assigned
Sep 28, 2016
Last updated
Oct 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Authorized official

Name
Lenin PetersNPI 1083638860
Title
Director of Contracting and Credent
Phone
(336) 883-0029

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 10

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Adolescent Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X

Addresses

Primary practice location

1580 Skeet Club Rd
High Point, NC 27265-9530

Mailing address

645 N Main St
High Point, NC 27260-5017
Phone (336) 883-0029

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013000729 NC Part B Supplier - Clinic/Group Practice 4486614575 Receives reassigned benefits from 88 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: High Point, NC; Winston Salem, NC; North Wilkesboro, NC; Mount Airy, NC; Kernersville, NC; Jamestown, NC; Greensboro, NC

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Locations

1580 Skeet Club Rd
#2
High Point, NC 27265

1908 Caudle Dr
Ste 100105
Mount Airy, NC 27030

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1255880571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 N MAIN ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272605017",
            "telephone_number": "336-883-0029",
            "fax_number": "336-899-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 SKEET CLUB RD",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272659530",
            "telephone_number": "336-883-0029",
            "fax_number": "336-899-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-28",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "LENIN",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING AND CREDENT",
        "authorized_official_telephone_number": "336-883-0029"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; 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.