Individual provider Active NPI

Beth L. Holthusen, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1467424515
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
100852 Issued in NC
Practice address
201 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone
(336) 774-9000
Fax
(336) 774-9012
NPI assigned
Feb 3, 2006
Last updated
Oct 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 100852 NC Primary

Addresses

Primary practice location

201 Executive Park Blvd
Winston Salem, NC 27103-1503

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 774-9000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bholthusen11206@direct.novanthealth.org
Direct Messaging Address BHOLTHUSEN11206@DIRECT.NOVANTHEALTH.ORG

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090619000544 NC Practitioner - Physician Assistant 7719038470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

201 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 774-9000

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

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

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 Apr 15, 2015 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Apr 15, 2015 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2000 Frontis Plaza Blvd
Ste 200
Winston Salem, NC 27103
Phone (336) 277-2435

201 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 774-0920

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

Interoperability endpoints

  • Direct secure messaging: bholthusen11206@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1467424515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-774-9000",
            "fax_number": "336-774-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 EXECUTIVE PARK BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031503",
            "telephone_number": "336-774-9000",
            "fax_number": "336-774-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTHUSEN",
        "first_name": "BETH",
        "middle_name": "L.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2020-10-29",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "100852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bholthusen11206@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "250 Charlois Blvd",
            "address_2": "DBA Winston-Salem Healthcare",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271031508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BHOLTHUSEN11206@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "201 Executive Park Blvd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271031503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.