Piedmont Cosmetic Surgery and Dermatology Center, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

400362 Issued in NC

Legal business name

PIEDMONT COSMETIC SURGERY AND DERMATOLOGY CENTER, PA

Practice address

765 Highland Oaks Dr
Suite 100
Winston Salem, NC 27103-7101

Phone

(336) 760-4004

Fax

(336) 760-6632

NPI assigned

Sep 22, 2006

Last updated

Jan 7, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Renee A Shandra

Title

Insurance/Billing

Phone

(336) 760-4004

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• David M Spencer, M.D

  • Specialist
  • Winston Salem, NC
  • NPI 1134143605
  Medicare reassignment Care Compare group NPD
• Beth Gurley, PA-C

  • Medical Physician Assistant
  • Clemmons, NC
  • NPI 1871515866
  Medicare reassignment Care Compare group
• Shilpa Satish Sawardekar, MD

  • Dermatology Physician
  • Statesville, NC
  • NPI 1134449622
  Medicare reassignment NPD
• Courtney Denise Edwards, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1730530312
  Medicare reassignment
• Marisa Scarlett Faircloth, PA-C

  • Physician Assistant
  • Thomasville, NC
  • NPI 1386887727
  Medicare reassignment
• Jennifer Ashley Savage, PA-C

  • Physician Assistant
  • New York, NY
  • NPI 1629578901

  NC

  Medicare reassignment

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1356440663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 HIGHLAND OAKS DR",
            "address_2": "SUITE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271037101",
            "telephone_number": "336-760-4004",
            "fax_number": "336-760-6632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 HIGHLAND OAKS DR",
            "address_2": "SUITE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271037101",
            "telephone_number": "336-760-4004",
            "fax_number": "336-760-6632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT COSMETIC SURGERY AND DERMATOLOGY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "SHANDRA",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "INSURANCE/BILLING",
        "authorized_official_telephone_number": "336-760-4004",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "400362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890238H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Piedmont Behavioral Counseling Center
• Piedmont Clinic, PLLC
• Piedmont Community Physicians PC (Vein Clinic of NC)
• Piedmont Community Physicians PC
• Piedmont Community Physicians PC (Vein Clinic of North Carolina)
• Piedmont Dialysis Center of Wake Forest University (Piedmont Dialysis Center)
• Piedmont Ear, Nose & Throat Associates, P.a. (Piedmont Ear, Nose, and Throat)
• Piedmont Endoscopy Center, Inc.
• Piedmont Family & Occupational Medicine Urgent Care PLLC
• Piedmont Family Healthcare

• Specialist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.