Individual provider Active NPI

Vontrelle Lynette Roundtree, M.D.

  • Family Medicine Physician
  • Greenville, NC
National Provider Identifier
1295092484
Registry record updated Dec 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2013-01880 Issued in NC
Practice address
101 Heart Dr
Greenville, NC 27834-8982
Phone
(252) 847-4267
Fax
(252) 847-1245
NPI assigned
Apr 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2013-01880 NC Primary

Addresses

Primary practice location

101 Heart Dr
Greenville, NC 27834-8982

Mailing address

PO Box 250
Beaver, PA 15009-0250
Phone (800) 634-0201

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vroundtree40039@direct.vidanthealth.com

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
I20151030000225 NC Practitioner - Family Practice 1254641475 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013-01880NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Dec 28, 2015 Accepting new patients

Locations

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

600 Moye Blvd
Greenville, NC 27834
Phone (252) 744-1111

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Organizations & group practices 1

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": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607731200000",
    "number": "1295092484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150090250",
            "telephone_number": "800-634-0201",
            "fax_number": "866-727-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HEART DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278348982",
            "telephone_number": "252-847-4267",
            "fax_number": "252-847-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUNDTREE",
        "first_name": "VONTRELLE",
        "middle_name": "LYNETTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-12",
        "last_updated": "2020-12-12",
        "certification_date": "2020-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2013-01880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vroundtree40039@direct.vidanthealth.com",
            "affiliation": "N",
            "address_1": "2100 Stantonsburg Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278342818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.