Individual provider Active NPI

Patrick Joseph McConville, MD

  • Anesthesiology Physician
  • Winston Salem, NC
National Provider Identifier
1356609507
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2017-01400 Issued in NC
Practice address
145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone
(336) 768-3212
Fax
(336) 768-9019
NPI assigned
Apr 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD0000050822 TN
Anesthesiology Physician 207L00000X 2017-01400 NC Primary

Addresses

Primary practice location

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983

Mailing address

145 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6983
Phone (336) 778-7572

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170912002512 NC Practitioner - Anesthesiology 0941503809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Ohio State University College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Triad Anesthesia PAGroup PAC ID 8426020025, 39 clinicians

Practice addresses (Care Compare)

145 Kimel Park Dr
Suite 120
Winston Salem, NC 27103-6983
Phone (336) 768-3212

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017-01400NCMDAnesthesiology Physician
MD0000050822TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Triad Anesthesia, PA Anesthesiology CurrentSince Jul 15, 2017 Accepting new patients

Locations

7210 Village Medical Cir
Ste 235
Clemmons, NC 27012
Phone (336) 893-3100

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

1730 Kernersville Medical Pkwy
Ste 304
Kernersville, NC 27284
Phone (336) 515-7000

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

1999 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-5181

111 Hanestown Ct
#151
Winston Salem, NC 27103
Phone (919) 334-0150

114 Charlois Blvd
Winston Salem, NC 27103

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

145 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-1770

4605 Country Club Rd
Winston Salem, NC 27104
Phone (336) 310-5038

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

2465 Hanestown Ln
Winston Salem, NC 27103
Phone (336) 201-0003

Organizations & group practices 1

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 2

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": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1356609507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-778-7572",
            "fax_number": "336-714-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036983",
            "telephone_number": "336-768-3212",
            "fax_number": "336-768-9019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONVILLE",
        "first_name": "PATRICK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD0000050822",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2017-01400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.