NPIMap

Individual provider Active NPI

Betsy W Southern, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1285691998
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-00149 Issued in NC
Practice address
145 Kimel Park Dr
330
Winston Salem, NC 27103-6984
Phone
(336) 765-6181
Fax
(336) 765-8492
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-00149 NC Primary

Addresses

Primary practice location

145 Kimel Park Dr
330
Winston Salem, NC 27103-6984

Mailing address

145 Kimel Park Dr
330
Winston Salem, NC 27103-6984
Phone (336) 765-6181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060222000605 NC Practitioner - Physician Assistant 5496761819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians
Oandw EnterprisesGroup PAC ID 6608927298, 216 clinicians

Practice addresses (Care Compare)

131 Miller St
Winston Salem, NC 27103-2508
Phone (336) 716-2734

510 Emergency Dr
Lexington, NC 27292-6804
Phone (336) 716-2255

935 Fairystone Park Hwy
Stanleytown, VA 24168-3014
Phone (888) 724-0268

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • Lexington Memorial Hospital Inc Hospital, Lexington, NC, CCN 340096
  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Wilkes Regional Medical Center Hospital, North Wilkesboro, NC, CCN 340064
  • Northern Regional Hospital Hospital, Mount Airy, NC, CCN 340003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-00149NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jan 1, 2015 Accepting new patients
Carolinas Pain Institute, PA Past Accepting new patients
Carolinas Pain Institute, PA Past Accepting new patients

Locations

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: bsouthern2755378@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1285691998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR",
            "address_2": "330",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036984",
            "telephone_number": "336-765-6181",
            "fax_number": "336-765-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR",
            "address_2": "330",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036984",
            "telephone_number": "336-765-6181",
            "fax_number": "336-765-8492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERN",
        "first_name": "BETSY",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.