NPIMap

Individual provider Active NPI

Bobby D Witten, M.D.

  • Family Medicine Physician
  • Archdale, NC
National Provider Identifier
1437159118
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2014-01181 Issued in NC
Practice address
10188 N Main St
Archdale, NC 27263-2906
Phone
(336) 802-2070
Fax
(336) 802-2071
NPI assigned
Jul 26, 2005
Reactivated
Mar 31, 2006
Last updated
Nov 29, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K9704 TX
Family Medicine Physician 207Q00000X 2014-01181 NC Primary
General Practice Physician 208D00000X 2014-01181 NC

Addresses

Primary practice location

10188 N Main St
Archdale, NC 27263-2906

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-1331

Other identifiers 3

IdentifierTypeStateIssuer
0064EJOtherTXBCBS
092429201MedicaidTX
092429202MedicaidTX

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
I20140926000901 NC Practitioner - Family Practice 5890819379 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at Houston, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

10188 N Main St
Archdale, NC 27263-2906
Phone (336) 802-2070

770 Highland Oaks Dr
Winston Salem, NC 27103-7105
Phone (336) 765-5250

905 Phillips Ave
High Point, NC 27262-7075
Phone (336) 802-2040

Medical Ctr Blvd
Winston Salem, NC 27157-0001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2014-01181NCMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Nov 1, 2023 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Sep 1, 2014 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Cornerstone Health Care, LLC Family Medicine CurrentSince Sep 1, 2014 Accepting new patients
Cornerstone Health Care PA Past Accepting new patients
Cornerstone Health Care LLC Past Accepting new patients

Locations

10188 N Main St
Archdale, NC 27263
Phone (336) 802-2070

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

711 National Hwy
Ste 100
Thomasville, NC 27360
Phone (336) 475-2000

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

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

Interoperability endpoints

  • Direct secure messaging: bwitten2754729@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 8

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1437159118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-716-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10188 N MAIN ST",
            "city": "ARCHDALE",
            "state": "NC",
            "postal_code": "272632906",
            "telephone_number": "336-802-2070",
            "fax_number": "336-802-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTEN",
        "first_name": "BOBBY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K9704",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2014-01181",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NC",
            "license": "2014-01181",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0064EJ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092429201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092429202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Archdale, NC

Sources for this page

Verify at the official NPI Registry.