Individual provider Active NPI

Susan Huggins Grainger, PNP

  • Nurse Practitioner
  • Kernersville, NC
National Provider Identifier
1306817671
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
300252 Issued in NC
Practice address
240 Broad St
Dba Forsyth Pediatric Assoc. - K'Ville
Kernersville, NC 27284-2930
Phone
(336) 993-8333
Fax
(336) 993-5144
NPI assigned
Jan 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 086287 NC
Nurse Practitioner 363L00000X 300252 NC Primary

Addresses

Primary practice location

240 Broad St
Dba Forsyth Pediatric Assoc. - K'Ville
Kernersville, NC 27284-2930

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other identifiers 1

IdentifierTypeStateIssuer
7005439MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgrainger16662@direct.novanthealth.org

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100209000395 NC Practitioner - Nurse Practitioner 8628111903 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
086287NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group LLC CurrentSince May 21, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 21, 2023 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

1471 Jag Branch Blvd
Unit 101
Kernersville, NC 27284
Phone (336) 515-7420

4901 Auburn Rd
Summerfield, NC 27358
Phone (336) 660-5270

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

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.

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1306817671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 BROAD ST",
            "address_2": "DBA FORSYTH PEDIATRIC ASSOC. - K'VILLE",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842930",
            "telephone_number": "336-993-8333",
            "fax_number": "336-993-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAINGER",
        "first_name": "SUSAN",
        "middle_name": "HUGGINS",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "086287",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "300252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005439",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgrainger16662@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "240 Broad St",
            "address_2": "DBA Forsyth Pediatric Assoc. - K'ville",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.