NPIMap

Individual provider Active NPI

Robert William Bynum IV, MD

  • Nephrology Physician
  • Wilson, NC
National Provider Identifier
1477525111
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
24731 Issued in NC
Practice address
2605 Forest Hills Rd SW Ste a
Wilson, NC 27893-4448
Phone
(252) 293-9898
Fax
(252) 293-9915
NPI assigned
Feb 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 24731 NC Primary

Addresses

Primary practice location

2605 Forest Hills Rd SW Ste a
Wilson, NC 27893-4448

Mailing address

2605 Forest Hills Rd SW Ste a
Wilson, NC 27893-4448
Phone (252) 293-9898

Other identifiers 2

IdentifierTypeStateIssuer
8920580MedicaidNC
20580OtherNCBLUE CROSS BLUE SHEILD

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
I20101124000083 NC Practitioner - Nephrology 1951207810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of North Carolina at Chapel Hill School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NC Kidney Care, PAGroup PAC ID 6608772561, 2 clinicians

Practice addresses (Care Compare)

2605 Forest Hills Rd SW
Suite a
Wilson, NC 27893-4448
Phone (252) 293-9898

Hospital & facility affiliations

  • DaVita Wilson Dialysis Dialysis facility, Wilson, NC, CCN 342507
  • FMC - Rocky Mount Kidney Center Dialysis facility, Rocky Mount, NC, CCN 342517
  • DaVita Forest Hills Dialysis Dialysis facility, Wilson, NC, CCN 342637
  • Well Care Home Health, Inc Home health agency, Raleigh, NC, CCN 347192
  • Centerwell Home Health Home health agency, Greenville, NC, CCN 347031
  • Wilson Medical Center Hospital, Wilson, NC, CCN 340126
  • Unc Health Nash Hospital, Rocky Mount, NC, CCN 340147

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24731NCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
N.C. Kidney Care, P.a. Nephrology CurrentSince Jun 1, 1999 Accepting new patients

Locations

2605 Forest Hills Rd SW
Ste A
Wilson, NC 27893
Phone (252) 243-0043

2402 Camden St SW
Ste 700
Wilson, NC 27893
Phone (252) 237-3142

1704 Glendale Dr SW
Ste H
Wilson, NC 27893
Phone (252) 293-9898

Interoperability endpoints

  • Direct secure messaging: robert.bynum@direct.davitaphysiciansolutions.com

Organizations & group practices 1

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 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": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1477525111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 FOREST HILLS RD SW STE A",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934448",
            "telephone_number": "252-293-9898",
            "fax_number": "252-293-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 FOREST HILLS RD SW STE A",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934448",
            "telephone_number": "252-293-9898",
            "fax_number": "252-293-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BYNUM",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2023-05-11",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "24731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8920580",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "20580",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

Verify at the official NPI Registry.