Individual provider Active NPI

Regina Gerard Kujawa, LCSW

  • Clinical Social Worker
  • Winston Salem, NC
National Provider Identifier
1447428693
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C005733 Issued in NC
Practice address
175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951
Phone
(336) 718-3550
Fax
(336) 277-1825
NPI assigned
Feb 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X C005753 NC
Social Worker 104100000X SW6677 FL
Clinical Social Worker 1041C0700X C005733 NC Primary

Addresses

Primary practice location

175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Other practice location 1

1904 Kello Dr
Greensboro, NC 27455
Phone (336) 286-6405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181203002766 NC Practitioner - Clinical Social Worker 9234198458 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

175 Kimel Park Dr
Suite 100
Winston Salem, NC 27103-6951
Phone (336) 718-3550

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW6677FLMDSocial Worker
C005753NCMDSocial Worker
C005733NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Psychiatric and Counseling Center PA Clinical CurrentSince Sep 12, 2018 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Feb 7, 2024 Accepting new patients
Regina Kujawa LCSW PLLC Clinical CurrentSince Mar 21, 2022 Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Feb 7, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

5603 W Friendly Ave
Ste B
Greensboro, NC 27410
Phone (336) 686-6894

603 Dolley Madison Rd
Ste 100
Greensboro, NC 27410
Phone (336) 632-3505

1175 Revolution Mill Dr
Ste 292
Greensboro, NC 27405
Phone (336) 457-0827

175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811

Organizations & group practices 5

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 1

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": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1447428693",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 KIMEL PARK DR STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036951",
            "telephone_number": "336-718-3550",
            "fax_number": "336-277-1825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1904 Kello Dr",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "27455",
            "country_code": "US",
            "telephone_number": "336-286-6405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUJAWA",
        "first_name": "REGINA",
        "middle_name": "GERARD",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-11",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NC",
            "license": "C005753",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW6677",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.