Advance Family and Sports Medicine Center, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ADVANCE FAMILY AND SPORTS MEDICINE CENTER, PLLC

Practice address

169 Yadkin Valley Rd
Suite 101
Advance, NC 27006-8786

Phone

(336) 940-2659

NPI assigned

Jun 28, 2010

Last updated

Nov 5, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Walter Ezeigbo, MDNPI 1306839659

Title

Owner/Ceo

Phone

(336) 940-2659

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8874/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Walter Azubuike Ezeigbo, MD

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1306839659
  Medicare reassignment NPD Authorized official
• Yolanda McClam Nicholson, FNP-C

  • Nurse Practitioner
  • Greensboro, NC
  • NPI 1609185255
  NPD

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1376854083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 YADKIN VALLEY RD",
            "address_2": "SUITE 101",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270068786",
            "telephone_number": "336-940-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 YADKIN VALLEY RD",
            "address_2": "SUITE 101",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270068786",
            "telephone_number": "336-940-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE FAMILY AND SPORTS MEDICINE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "EZEIGBO",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "336-940-2659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam T. Dorsett, DDS, and Jason T. Moore, DDS, PA
• Advance Pediatrics, PC
• Advance Rehabilitation and Nursing
• Devan Allred, PTA
• Stefanie Marie Alvis, PA-C
• Amy Li DMD (Amy Li DMD PLLC)

• Family Medicine Physician in Advance, NC
• Providers in Advance, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.