Individual provider Active NPI

Sarah Elizabeth Connolly, MD

  • Vascular & Interventional Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1285955229
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
2020-02779 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-1016
Phone
(336) 716-2255
NPI assigned
Jun 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2015010880 MO
Vascular & Interventional Radiology Physician 2085R0204X 2020-02779 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-1016

Mailing address

660 S Euclid Ave
CB 8131
Saint Louis, MO 63110-1010
Phone (314) 362-7200

Other practice location 1

510 S Kingshighway Blvd
Saint Louis, MO 63110-1016
Phone (314) 362-7200

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidIL
1285955229MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200820002467 NC Practitioner - Interventional Radiology 5294964763 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2020-02779NCMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Baptist Imaging LLC Diagnostic Radiology CurrentSince Sep 27, 2024 Accepting new patients
Wake Forest University Health Sciences CurrentSince Sep 1, 2020 Accepting new patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Sep 14, 2020 Accepting new patients

Locations

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

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1285955229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CB 8131",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271571016",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 S Kingshighway Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101016",
            "country_code": "US",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "SARAH",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2015010880",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NC",
            "license": "2020-02779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285955229",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.