NPIMap

Individual provider Active NPI

Mitchell Martucci Somma, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1346330636
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-04998 Issued in NC
Practice address
1901 S Hawthorne Rd Ste 220
Winston Salem, NC 27103-3914
Phone
(336) 718-6777
Fax
(336) 718-6773
NPI assigned
Oct 15, 2006
Last updated
Jun 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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 0010-04998 NC Primary

Addresses

Primary practice location

1901 S Hawthorne Rd Ste 220
Winston Salem, NC 27103-3914

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-1440

Other practice location 1

250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone (336) 718-1440

Other identifiers 3

IdentifierTypeStateIssuer
45573OtherUNIVERSITY HEALTHPLAN
P3289761OtherOXFORD
3K6516OtherHEALTHNET

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msomma165226@direct.novanthealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141103001571 NC Practitioner - Physician Assistant 1658340716 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince May 1, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 1, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Aug 10, 2014 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Aug 10, 2014 Accepting new patients
Forsyth Memorial Hospital, Inc Physician Assistant Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

1901 S Hawthorne Rd
Ste 210
Winston Salem, NC 27103
Phone (336) 718-5000

1901 S Hawthorne Rd
Ste 220
Winston Salem, NC 27103
Phone (336) 718-6777

250 Charlois Blvd
Winston Salem, NC 27103
Phone (336) 718-1000

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

Interoperability endpoints

  • Direct secure messaging: msomma165226@direct.novanthealth.org

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 7

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": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1346330636",
    "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": "336-718-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S HAWTHORNE RD STE 220",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033914",
            "telephone_number": "336-718-6777",
            "fax_number": "336-718-6773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1440",
            "fax_number": "336-718-1173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOMMA",
        "first_name": "MITCHELL",
        "middle_name": "MARTUCCI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-15",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTHPLAN",
            "identifier": "45573",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3289761",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3K6516",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msomma165226@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "250 Charlois Blvd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271031508",
            "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.