NPIMap

Organization Active NPI

Carolinas Pain Institute, PA

  • Pain Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1376598268
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
30458 Issued in NC
Legal business name
CAROLINAS PAIN INSTITUTE, PA
Practice address
145 Kimel Park Dr
Suite 330
Winston Salem, NC 27103-6984
Phone
(336) 765-6181
Fax
(336) 765-8492
NPI assigned
May 23, 2006
Last updated
Aug 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Authorized official

Name
Richard Lee Rauck, MD
Title
President
Phone
(336) 765-6181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 30458 NC Primary

Addresses

Primary practice location

145 Kimel Park Dr
Suite 330
Winston Salem, NC 27103-6984

Mailing address

145 Kimel Park
Suite 330
Winston Salem, NC 27103
Phone (336) 765-6181

Other practice location 1

110 Dutchmans Court
Elkin, NC 28621
Phone (336) 765-6181

Other practice location 2

708 S South St Ste 400
Mount Airy, NC 27030-4589
Phone (336) 765-6181

Other identifiers 3

IdentifierTypeStateIssuer
7970536MedicaidNC
5902221MedicaidNC
70536OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000338 NC Part B Supplier - Clinic/Group Practice 0244218550 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
Practice locations: Charlotte, NC; Winston Salem, NC

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1376598268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK",
            "address_2": "SUITE 330",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-765-6181",
            "fax_number": "336-765-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR",
            "address_2": "SUITE 330",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036984",
            "telephone_number": "336-765-6181",
            "fax_number": "336-765-8492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Dutchmans Court",
            "address_purpose": "LOCATION",
            "city": "Elkin",
            "state": "NC",
            "postal_code": "28621",
            "country_code": "US",
            "telephone_number": "336-765-6181",
            "fax_number": "336-760-2149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "708 S South St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Mount Airy",
            "state": "NC",
            "postal_code": "270304589",
            "country_code": "US",
            "telephone_number": "336-765-6181",
            "fax_number": "336-760-2149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINAS PAIN INSTITUTE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "RAUCK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-765-6181",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NC",
            "license": "30458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7970536",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902221",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "70536",
            "state": null
        }
    ],
    "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 Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.