Individual provider Active NPI

Katherine Ann Bozylinsky, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1487808523
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-10931 Issued in NC
Practice address
500 Shepherd St Ste 500
Winston Salem, NC 27103-1633
Phone
(336) 716-4039
Fax
(336) 768-3497
NPI assigned
Nov 14, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 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 085003321 IL
Physician Assistant 363A00000X 0010-10931 NC Primary

Addresses

Primary practice location

500 Shepherd St Ste 500
Winston Salem, NC 27103-1633

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-4039

Other practice location 1

2020 W Harrison St
Chicago, IL 60612-3741
Phone (312) 572-4675

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Kforce@direct.ccprovider.org Direct Cook County

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
I20230605000461 NC Practitioner - Physician Assistant 0749455715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

2341 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

500 Shepherd St
Winston Salem, NC 27103-1633
Phone (336) 716-2734

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-10931NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince May 1, 2023 Accepting new patients

Locations

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

500 Shepherd St
Ste 500
Winston Salem, NC 27103
Phone (336) 716-4039

Interoperability endpoints

  • Direct secure messaging: kforce@direct.ccprovider.org
  • Direct secure messaging: kbozylinsky2755621@carolinashealthcaresystem.direct-ci.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 5

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": "1226620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1487808523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-4039",
            "fax_number": "336-768-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SHEPHERD ST STE 500",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031633",
            "telephone_number": "336-716-4039",
            "fax_number": "336-768-3497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 W Harrison St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123741",
            "country_code": "US",
            "telephone_number": "312-572-4675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOZYLINSKY",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-14",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003321",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kforce@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "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.