NPIMap

Individual provider Active NPI

Edwin Francois Xavier Villert, PA

  • Physician Assistant
  • Cary, NC
National Provider Identifier
1467050120
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12221 Issued in NC
Practice address
Matrix Occupational Health PC
1110 Kildaire Farm Road
Cary, NC 27511
Phone
(919) 481-0277
Fax
(919) 481-9777
NPI assigned
Oct 15, 2020
Last updated
Oct 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9113585 FL
Physician Assistant 363A00000X 0010-12221 NC Primary

Addresses

Primary practice location

Matrix Occupational Health PC
1110 Kildaire Farm Road
Cary, NC 27511

Mailing address

1028 Slater Rd Apt 201
Durham, NC 27703-8468
Phone (904) 844-1594

Other practice location 1

1509 Doctors Cir Bldg C
Wilmington, NC 28401-7403
Phone (910) 662-7500

Other practice location 2

1515 SW Archer Rd
Gainesville, FL 32608-1134
Phone (352) 265-0111

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
I20220803003241 NC Practitioner - Physician Assistant 0143630426 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Duke University Health System, IncGroup PAC ID 2567372345, 1,083 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 343-9800

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-5000

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Aug 6, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Aug 6, 2023 Accepting new patients
Duke University Health System, Inc. CurrentSince Jun 6, 2022 Accepting new patients
Duke University Health System, Inc. CurrentSince Jun 6, 2022 Accepting new patients
NMG Health Services LLC CurrentSince Nov 1, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Nov 27, 2022 Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Nov 1, 2022 Accepting new patients
Shands Teaching Hospital and Clinics Inc PastSince Oct 1, 2020 Accepting new patients

Locations

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

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

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1509 Doctors Cir
Bldg C
Wilmington, NC 28401
Phone (910) 662-7550

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Interoperability endpoints

  • Direct secure messaging: evillert1102572@direct.novanthealth.org
  • Direct secure messaging: evillert518870@direct.medicine.duke.edu

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 11

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": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1467050120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 SLATER RD APT 201",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277038468",
            "telephone_number": "904-844-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MATRIX OCCUPATIONAL HEALTH PC",
            "address_2": "1110 KILDAIRE FARM ROAD",
            "city": "CARY",
            "state": "NC",
            "postal_code": "27511",
            "telephone_number": "919-481-0277",
            "fax_number": "919-481-9777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1509 Doctors Cir Bldg C",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017403",
            "country_code": "US",
            "telephone_number": "910-662-7500",
            "fax_number": "910-662-7501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1515 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326081134",
            "country_code": "US",
            "telephone_number": "352-265-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLERT",
        "first_name": "EDWIN",
        "middle_name": "FRANCOIS XAVIER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-15",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113585",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.