NPIMap

Organization Active NPI

Miller Street Dialysis Center of Wake Forest University

Doing business as Miller Street Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Winston Salem, NC
National Provider Identifier
1407000540
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MILLER STREET DIALYSIS CENTER OF WAKE FOREST UNIVERSITY
Doing business as
Miller Street Dialysis Center
Practice address
120 Miller St
Winston Salem, NC 27103-2509
Phone
(336) 721-4801
Fax
(336) 721-4861
NPI assigned
Nov 14, 2008
Last updated
Feb 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

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

Authorized official

Name
Ms. Kimberly Agee-Clark Johnson, MBA
Title
Credentialing Coord.
Phone
(229) 387-3528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

120 Miller St
Winston Salem, NC 27103-2509

Mailing address

PO Box 7350
Tifton, GA 31793-7350
Phone (229) 387-3528

Other identifiers 1

IdentifierTypeStateIssuer
3402667MedicaidNC

Other names 1

  • Miller Street Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090326000557 NC Part A Provider - End-Stage Renal Disease Facility (ESRD) 2466519988 Practice locations: Winston Salem, NC

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Miller Street Dialysis CenterCCN 342667
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Jun 5, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Chain
Wake Forest University
Dialysis stations
48

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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
34D1092234Miller Street Dialysis Center of Wake Forest120 Miller Street, Winston-Salem, NC 27103Certificate of waiverNov 19, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1407000540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7350",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317937350",
            "telephone_number": "229-387-3528",
            "fax_number": "229-386-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MILLER ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032509",
            "telephone_number": "336-721-4801",
            "fax_number": "336-721-4861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLER STREET DIALYSIS CENTER OF WAKE FOREST UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "AGEE-CLARK",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "229-387-3528",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3402667",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miller Street Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.