NPIMap

Organization Active NPI

Triad Psychiatric and Counseling Center PA

Doing business as TPCC, PA

  • Psychiatry Physician
  • Greensboro, NC
National Provider Identifier
1285671602
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
38415 Issued in NC
Legal business name
TRIAD PSYCHIATRIC AND COUNSELING CENTER PA
Doing business as
TPCC, PA
Practice address
603 Dolley Madison Rd Ste 100
Greensboro, NC 27410-4282
Phone
(336) 632-3505
Fax
(336) 632-3503
NPI assigned
Jun 2, 2006
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Authorized official

Name
Roy Kavuri
Title
Adminstrator
Phone
(336) 632-3505

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 2270 NC
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 38415 NC Primary

Addresses

Primary practice location

603 Dolley Madison Rd Ste 100
Greensboro, NC 27410-4282

Mailing address

603 Dolley Madison Rd Ste 100
Greensboro, NC 27410-4283
Phone (336) 632-3505

Other practice location 1

1119 Spruce St
Marinsville, VA 21142
Phone (336) 632-3505 ext. 603

Other identifiers 1

IdentifierTypeStateIssuer
890283KMedicaidNC

Other names 1

  • TPCC, PA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040913000973 NC Part B Supplier - Clinic/Group Practice 3173590882 Receives reassigned benefits from 37 practitioners
Practice locations: Greensboro, NC; Winston Salem, NC
O20080512000760 VA Part B Supplier - Clinic/Group Practice 3173590882 Receives reassigned benefits from 6 practitioners
Practice locations: Danville, VA; Martinsville, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2303336Triad Psychiatric & Counseling Center, PA603 Dolley Madison Rd, Suite 100, Greensboro, NC 27410Certificate of waiverApr 23, 2028

National Provider Directory

National Provider Directory

Locations

3511 W Market St
Ste 100
Greensboro, NC 27403
Phone (336) 522-8999

522 N Elam Ave
Ste 101
Greensboro, NC 27403
Phone (336) 632-3505

1119 Spruce St
Martinsville, VA 24112
Phone (276) 638-3505

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1285671602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 DOLLEY MADISON RD STE 100",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274104283",
            "telephone_number": "336-632-3505",
            "fax_number": "336-632-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 DOLLEY MADISON RD STE 100",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274104282",
            "telephone_number": "336-632-3505",
            "fax_number": "336-632-3503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1119 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Marinsville",
            "state": "VA",
            "postal_code": "21142",
            "country_code": "US",
            "telephone_number": "336-632-3505 x603",
            "fax_number": "336-632-3503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRIAD PSYCHIATRIC AND COUNSELING CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "KAVURI",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "336-632-3505"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "NC",
            "license": "2270",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "38415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890283K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TPCC, PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TPCC, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.

Verify at the official NPI Registry.