Individual provider Active NPI

Sarah Elizabeth Gray Mikac, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1376021485
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11418 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-1484
Phone
(336) 716-6674
Fax
(336) 716-9188
NPI assigned
Jul 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0006964 MD
Physician Assistant 363A00000X MD
Physician Assistant 363A00000X 0010-11418 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-1484

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-6674

Other practice location 1

1500 Forest Glen Rd
Silver Spring, MD 20910-1484
Phone (301) 754-7111

Other names 1

  • Miss Sarah Elizabeth Gray 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
I20220119002917 NC Practitioner - Physician Assistant 6406190784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

2341 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0006964MDMDPhysician Assistant
0010-11418NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jan 1, 2022 Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: smikac2755234@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

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": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1376021485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-6674",
            "fax_number": "336-716-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271571484",
            "telephone_number": "336-716-6674",
            "fax_number": "336-716-9188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Forest Glen Rd",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209101484",
            "country_code": "US",
            "telephone_number": "301-754-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKAC",
        "first_name": "SARAH",
        "middle_name": "ELIZABETH GRAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-01-10",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0006964",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "GRAY",
            "middle_name": "ELIZABETH",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.