NPIMap

Individual provider Active NPI

Christopher Marcus Lack, M.D. PH.D.

  • Diagnostic Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1427222454
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2009-01865 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-3465
NPI assigned
Apr 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2009-01865 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001

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
I20091116000499 NC Practitioner - Diagnostic RadiologyPractitioner - Family Practice 3375681133 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians
Wake Forest Baptist Imaging LLCGroup PAC ID 3173681681, 76 clinicians

Practice addresses (Care Compare)

1814 Westchester Dr
Suite 100
High Point, NC 27262-7369
Phone (336) 802-2175

265 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009-01865NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Jul 1, 2014 Accepting new patients
Wake Forest Baptist Imaging LLC Diagnostic Radiology CurrentSince Sep 27, 2024 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2014 Accepting new patients

Locations

223 W Ward St
Ste B
Asheboro, NC 27203
Phone (336) 702-1731

223 W Ward St
#B
Asheboro, NC 27203

1814 Westchester Dr
Ste 100
High Point, NC 27262
Phone (336) 802-2397

402 W King St
King, NC 27021
Phone (336) 529-4304

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1427222454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACK",
        "first_name": "CHRISTOPHER",
        "middle_name": "MARCUS",
        "name_prefix": "Dr.",
        "credential": "M.D. PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2009-01865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.