NPIMap

Individual provider Active NPI

Meagan Boles Laberge, P.A.-C

  • Physician Assistant
  • Rural Hall, NC
National Provider Identifier
1316288228
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-04104 Issued in NC
Practice address
1038 Bethania Rural Hall Rd
Rural Hall, NC 27045-9552
Phone
(336) 716-9270
NPI assigned
Mar 4, 2013
Last updated
Oct 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-04104 NC Primary
Medical Physician Assistant 363AM0700X 0010-04104 NC

Addresses

Primary practice location

1038 Bethania Rural Hall Rd
Rural Hall, NC 27045-9552

Mailing address

Provider Enrollment
100 Kimel Forest Drive
Winston-Salem, NC 27103-6074
Phone (336) 713-0947

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
I20141029000610 NC Practitioner - Physician Assistant 0547481947 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1038 Bethania Rural Hall Rd
Rural Hall, NC 27045-9552
Phone (336) 716-2255

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-04104NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Aug 1, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jul 25, 2016 Accepting new patients
Novant Health Medical Group LLC CurrentSince Jul 25, 2016 Accepting new patients

Locations

2311 Lewisville Clemmons Rd
Fl 3
Clemmons, NC 27012
Phone (336) 713-8900

402 W King St
King, NC 27021
Phone (336) 529-4304

1188 Yadkinville Rd
Mocksville, NC 27028
Phone (336) 716-7435

1038 Bethania Rural Hall Rd
Rural Hall, NC 27045
Phone (336) 716-9270

290 W Wall St
Rural Hall, NC 27045
Phone (336) 969-1185

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

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

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

Interoperability endpoints

  • Direct secure messaging: mlaberge954655@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1362355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1316288228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PROVIDER ENROLLMENT",
            "address_2": "100 KIMEL FOREST DRIVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-713-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1038 BETHANIA RURAL HALL RD",
            "city": "RURAL HALL",
            "state": "NC",
            "postal_code": "270459552",
            "telephone_number": "336-716-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABERGE",
        "first_name": "MEAGAN",
        "middle_name": "BOLES",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-04",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04104",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-04104",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rural Hall, NC

Sources for this page

Verify at the official NPI Registry.