Individual provider Active NPI

Leslie Wiley Nifong, M.D.

  • Surgery Physician
  • Greenville, NC
National Provider Identifier
1366858086
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
9800988 Issued in NC
Practice address
115 Heart Dr
Greenville, NC 27834-8982
Phone
(252) 744-2187
Fax
(252) 744-3542
NPI assigned
Jul 2, 2014
Last updated
Feb 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 98-00988 NC
Surgery Physician 208600000X 9800988 NC Primary

Addresses

Primary practice location

115 Heart Dr
Greenville, NC 27834-8982

Mailing address

PO Box 751069
Charlotte, NC 28275-1069

Other identifiers 2

IdentifierTypeStateIssuer
1366858086MedicaidNC
1897FOtherNCBCBS NC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lnifong76731@direct.ecuhealth.com Health Information Exchange (HIE)

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
I20150226001005 NC Practitioner - Cardiac SurgeryPractitioner - General Surgery 7719203363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac SurgeryAlso: General Surgery
Education
Brody School of Medicine at East Carolina University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina UniversityGroup PAC ID 0244143246, 499 clinicians

Practice addresses (Care Compare)

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 209-3000

600 Moye Blvd
Greenville, NC 27834-4300
Phone (252) 744-4611

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)12
Pacemaker insertion or repair1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
98-00988NCMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University Surgery CurrentSince Jan 5, 2015 Accepting new patients
East Carolina University Current Accepting new patients
East Carolina University Past Accepting new patients

Locations

115 Heart Dr
Greenville, NC 27834
Phone (252) 744-4400

600 Moye Blvd
Greenville, NC 27834
Phone (252) 744-1111

Interoperability endpoints

  • Direct secure messaging: lnifong76731@direct.ecuhealth.com

Organizations & group practices 3

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 5

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": "1404259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1366858086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751069",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 HEART DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278348982",
            "telephone_number": "252-744-2187",
            "fax_number": "252-744-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIFONG",
        "first_name": "LESLIE",
        "middle_name": "WILEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-02",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "98-00988",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "9800988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366858086",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "1897F",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnifong76731@direct.ecuhealth.com",
            "affiliation": "N",
            "endpointDescription": "ECU Physicians",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "115 Heart Dr",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278348982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.