NPIMap

Individual provider Active NPI

Reginald Jaye Fowler Jr., MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Winston Salem, NC
National Provider Identifier
1386626240
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
200301462 Issued in NC
Practice address
3001 Lyndhurst Ave
Winston-Salem, NC 27103
Phone
(336) 765-0383
Fax
(336) 768-1737
NPI assigned
Nov 16, 2005
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 200301462 NC Primary
Pulmonary Disease Physician 207RP1001X 200301462 NC

Addresses

Primary practice location

3001 Lyndhurst Ave
Winston-Salem, NC 27103

Mailing address

3001 Lyndhurst Ave
Winston-Salem, NC 27103
Phone (336) 765-0383

Other identifiers 1

IdentifierTypeStateIssuer
891351FMedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rfowler140409@direct.novanthealth.org Direct Spectrum Medical Group PA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040212000739 NC Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 1951295583 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Spectrum Medical Group PAGroup PAC ID 1254234388, 15 clinicians

Practice addresses (Care Compare)

1969 Wellness Blvd
Monroe, NC 28110-7763
Phone (704) 316-5775

3001 Lyndhurst Ave
Winston Salem, NC 27103-4007
Phone (336) 765-0383

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200301462NCMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Spectrum Medical Group PA Critical Care Medicine CurrentSince Dec 5, 2003 Accepting new patients

Locations

3001 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 765-0383

Interoperability endpoints

  • Direct secure messaging: reginaldfowler@scspec.allscriptsdirect.net
  • Direct secure messaging: rfowler140409@direct.novanthealth.org

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 10

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": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1386626240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-765-0383",
            "fax_number": "336-768-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-765-0383",
            "fax_number": "336-768-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "REGINALD",
        "middle_name": "JAYE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "200301462",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "200301462",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891351F",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rfowler140409@direct.novanthealth.org",
            "affiliation": "Y",
            "affiliationName": "Spectrum Medical Group PA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3001 Lyndhurst Ave",
            "city": "Winston-Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271034007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.