NPIMap

Organization Active NPI

Iclinic, PA

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1316999691
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9900918 Issued in NC
Legal business name
ICLINIC, PA
Practice address
755 Highland Oaks Dr
Suite 202
Winston-Salem, NC 27103-7106
Phone
(336) 760-0070
Fax
(336) 760-0017
NPI assigned
May 16, 2006
Last updated
Jun 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Authorized official

Name
Dr. Giovanni Llibre, MD
Title
Owner
Phone
(336) 760-0070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9900918 NC Primary

Addresses

Primary practice location

755 Highland Oaks Dr
Suite 202
Winston-Salem, NC 27103-7106

Mailing address

755 Highland Oaks Dr
Suite 202
Winston-Salem, NC 27103-7106
Phone (336) 760-0070

Other identifiers 2

IdentifierTypeStateIssuer
016XTOtherNCBCBS OF NORTH CAROLINA
5950540MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1316999691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 HIGHLAND OAKS DR",
            "address_2": "SUITE 202",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271037106",
            "telephone_number": "336-760-0070",
            "fax_number": "336-760-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 HIGHLAND OAKS DR",
            "address_2": "SUITE 202",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271037106",
            "telephone_number": "336-760-0070",
            "fax_number": "336-760-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "LLIBRE",
        "authorized_official_first_name": "GIOVANNI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-760-0070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9900918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NORTH CAROLINA",
            "identifier": "016XT",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950540",
            "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 Jun 18, 2009; 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.