Active NPI
Kerry J. Gilliland, MD
- Cardiovascular Disease Physician
- Winston Salem, NC
National Provider Identifier
1316918683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 20904
- Practice address
- 186 Kimel Park Dr
Winston Salem, NC 27103-6946 - Phone
- (336) 277-2000
- Fax
- (336) 277-2050
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 20904 | NC | Primary |
Addresses
Primary practice location
186 Kimel Park Dr
Winston Salem, NC 27103-6946
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 277-2000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316918683 | Medicaid | VA | |
| 142 | Other | NC | PARTNERS ID# |
| 1285682310 | Other | NC | WSCA GRP NPI # |
| 35557 | Other | NC | BCBS ID# |
| 8935557 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20904 | NC | MD | Massage Therapist |
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": "1360195200000",
"number": "1316918683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803",
"telephone_number": "336-277-2000",
"fax_number": "336-277-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 KIMEL PARK DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-277-2000",
"fax_number": "336-277-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLILAND",
"first_name": "KERRY",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-27",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NC",
"license": "20904",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1316918683",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS ID#",
"identifier": "142",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WSCA GRP NPI #",
"identifier": "1285682310",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID#",
"identifier": "35557",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8935557",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.