Individual provider Active NPI

Kaitlyn Walisiewicz, PA-C

  • Physician Assistant
  • Greensboro, NC
National Provider Identifier
1336790278
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-09367 Issued in NC
Practice address
501 N Elam Ave
Greensboro, NC 27403-1118
Phone
(336) 832-1100
NPI assigned
Sep 23, 2019
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-09367 NC Primary

Addresses

Primary practice location

501 N Elam Ave
Greensboro, NC 27403-1118

Mailing address

PO Box 10467
Greensboro, NC 27404-0467
Phone (336) 207-7005

Other practice location 1

1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 207-7005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200107001675 NC Practitioner - Physician Assistant 0749614386 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 N Elam Ave
Greensboro, NC 27403-1118
Phone (336) 832-1100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Moses H Cone Memorial Hospital Operating Corporation Physician Assistant CurrentSince Sep 15, 2022 Accepting new patients
Alamance Regional Medical Center, Inc CurrentSince Sep 15, 2022 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation CurrentSince Sep 15, 2022 Accepting new patients
Wake Forest Baptist Health PastSince Oct 24, 2021 Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation Past Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

2400 W Friendly Ave
Greensboro, NC 27403
Phone (336) 832-1100

618 S Main St
Reidsville, NC 27320
Phone (336) 832-7965

Organizations & group practices 7

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 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": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1336790278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10467",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274040467",
            "telephone_number": "336-207-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N ELAM AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031118",
            "telephone_number": "336-832-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N Elm St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011004",
            "country_code": "US",
            "telephone_number": "336-207-7005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALISIEWICZ",
        "first_name": "KAITLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2022-07-21",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.