Forsyth Memorial Hospital Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FORSYTH MEMORIAL HOSPITAL INC

Practice address

12208 N NC Highway 150
Winston Salem, NC 27127-9730

Phone

(336) 764-2324

Fax

(336) 764-9541

NPI assigned

May 4, 2006

Organization subpart

No

Name

Leea Jeanine Walton

Title

RCS Manager

Phone

(704) 316-6081

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lauren Stella Glova, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1376403170
  NPD
• Cara Secrest Watson, FNP

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1285319053
  NPD

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in NC

Locations

• Novant Health Arcadia Family Medicine Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 10, 2023.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1427006451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-764-2324",
            "fax_number": "336-764-9541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12208 N NC HIGHWAY 150",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271279730",
            "telephone_number": "336-764-2324",
            "fax_number": "336-764-9541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORSYTH MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "01126",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE MEDICARE",
            "identifier": "2688",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA1315",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6901126",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Arcadia Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Arcadia Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc
• Forsyth Memorial Hospital Inc

• All providers in Winston Salem, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.