NPIMap

Organization Active NPI

Wake Forest University Baptist Medical Center Community Physicians

Doing business as Pine Ridge Family Practice

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1316930654
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Doing business as
Pine Ridge Family Practice
Practice address
7990 North Point Blvd
Winston Salem, NC 27106-3259
Phone
(336) 896-1100
Fax
(336) 896-1146
NPI assigned
Aug 23, 2005
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
Mr. Lewis S Thorp III
Title
President Ceo
Phone
(336) 721-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X NC Primary

Addresses

Primary practice location

7990 North Point Blvd
Winston Salem, NC 27106-3259

Mailing address

7990 North Point Blvd
Winston Salem, NC 27106-3259
Phone (336) 896-1100

Other identifiers 2

IdentifierTypeStateIssuer
2317728HOtherNCMEDICARE GROUP NUMBER
890244TMedicaidNC

Other names 1

  • Pine Ridge Family Practice Doing business as

National Provider Directory

National Provider Directory
Part of
Argis Family Health Cente

Locations

3540 Clemmons Rd
#4317
Clemmons, NC 27012

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1316930654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7990 NORTH POINT BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063259",
            "telephone_number": "336-896-1100",
            "fax_number": "336-896-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7990 NORTH POINT BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063259",
            "telephone_number": "336-896-1100",
            "fax_number": "336-896-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "enumeration_date": "2005-08-23",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "THORP",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "336-721-3900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890244T",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.