Organization Active NPI

Preventative Wellness Solutions II, PLLC

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1376296152
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREVENTATIVE WELLNESS SOLUTIONS II, PLLC
Practice address
3878 Oxford Station Way
Winston Salem, NC 27103-1340
Phone
(813) 228-6334
NPI assigned
Feb 1, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Authorized official

Name
John Kaloust
Title
Manager
Phone
(813) 228-6334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Obesity Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QB0002X

Addresses

Primary practice location

3878 Oxford Station Way
Winston Salem, NC 27103-1340

Mailing address

509 S Hyde Park Ave
Tampa, FL 33606-2266
Phone (813) 228-6334

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2253596Preventative Wellness Solutions II PLLC3878 Oxford Station Way, Winston-Salem, NC 27103Certificate of waiverFeb 22, 2028

National Provider Directory

National Provider Directory

Locations

3878 Oxford Station Way
Winston Salem, NC 27103
Phone (336) 306-5900

NPI Registry JSON

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1376296152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S HYDE PARK AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062266",
            "telephone_number": "813-228-6334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3878 OXFORD STATION WAY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031340",
            "telephone_number": "813-228-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTATIVE WELLNESS SOLUTIONS II, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "KALOUST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-228-6334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.