Individual provider Active NPI

Caitlin Ontiveros, PA-C

  • Physician Assistant
  • Clemmons, NC
National Provider Identifier
1346921913
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-14694 Issued in NC
Practice address
7210 Village Medical Cir Ste 310
Clemmons, NC 27012-8041
Phone
(336) 277-4075
Fax
(336) 277-4070
NPI assigned
Jul 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 0010-14694 NC Primary

Addresses

Primary practice location

7210 Village Medical Cir Ste 310
Clemmons, NC 27012-8041

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 277-4075

Other names 1

  • Caitlin Tominey Former name

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
I20241204001674 NC Practitioner - Physician Assistant 7214463074 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
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)

1471 Jag Branch Blvd
Kernersville, NC 27284-6963

1750 Kernersville Med PK
Kernersville, NC 27284-7146
Phone (336) 564-4727

1750 Kernersville Medical Pkwy
Kernersville, NC 27284-7146
Phone (336) 564-4866

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 277-1717

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

6915 Village Medical Cir
Clemmons, NC 27012-8002
Phone (336) 718-7080

7210 Village Medical Cir
Clemmons, NC 27012-8029

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Nov 2, 2024 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 2, 2024 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

7210 Village Medical Cir
Ste 310
Clemmons, NC 27012
Phone (336) 277-4075

1471 Jag Branch Blvd
Unit 105
Kernersville, NC 27284
Phone (336) 277-4075

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

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

Interoperability endpoints

  • Direct secure messaging: contiveros1612342@direct.novanthealth.org

Organizations & group practices 4

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": "1690416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771891200000",
    "number": "1346921913",
    "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": "336-277-4075",
            "fax_number": "336-277-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 VILLAGE MEDICAL CIR STE 310",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128041",
            "telephone_number": "336-277-4075",
            "fax_number": "336-277-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONTIVEROS",
        "first_name": "CAITLIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-27",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAITLIN",
            "last_name": "TOMINEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clemmons, NC

Sources for this page

Verify at the official NPI Registry.