Individual provider Active NPI

John Heyl Gibson, M.D.

  • Neurology Physician
  • Winston Salem, NC
National Provider Identifier
1326057928
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2006-00136 Issued in NC
Practice address
190 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6946
Phone
(336) 277-2200
Fax
(336) 277-2210
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Psychiatry & Neurology) Physician 2084H0002X 36445 SC
Neurology Physician 2084N0400X 36445 SC
Neurology Physician 2084N0400X 2006-00136 NC Primary

Addresses

Primary practice location

190 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6946

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 277-2200

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Other identifiers 1

IdentifierTypeStateIssuer
P00605571OtherNCRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgibson770184@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070810000363 NC Practitioner - Neurology 7618068263 Reassigns benefits to 1 organization
I20140215000000 SC Practitioner - Hospice/Palliative CarePractitioner - Neurology 7618068263 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Wake Forest University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

152 E Kinderton Way
Suite 101
Bermuda Run, NC 27006-7351
Phone (336) 893-3180

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2006-00136NCMDNeurology Physician
36445SCMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Dec 24, 2019 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties Current Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Aug 25, 2015 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Neurology CurrentSince Aug 25, 2015 Accepting new patients
Novant Health Medical Group, LLC Neurology CurrentSince Dec 24, 2019 Accepting new patients
University Medical Associates of the Medical University of South Carol Neurology CurrentSince Dec 28, 2013 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

152 E Kinderton Way
Ste 101
Bermuda Run, NC 27006
Phone (336) 893-3180

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

125 Queens Rd
Charlotte, NC 28204
Phone (980) 302-6380

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

2290 Remount Rd
Gastonia, NC 28054
Phone (704) 316-4979

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

1219 Lexington Ave
Ste B
Thomasville, NC 27360
Phone (336) 475-0113

190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200

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

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/0fba742b-eec1-4103-87e5-edbdf1fe1e30/

Organizations & group practices 10

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.

Hospital & facility affiliations 1

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1326057928",
    "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",
            "telephone_number": "336-277-2200",
            "fax_number": "336-277-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-277-2200",
            "fax_number": "336-277-2210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JOHN",
        "middle_name": "HEYL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084H0002X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Hospice and Palliative Medicine",
            "state": "SC",
            "license": "36445",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "36445",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NC",
            "license": "2006-00136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00605571",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgibson770184@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294258908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.