NPIMap

Organization Active NPI

Bethany Medical Center, PA

  • Family Medicine Physician
  • High Point, NC
National Provider Identifier
1508459306
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BETHANY MEDICAL CENTER, PA
Practice address
819 N Main St Ste 112
High Point, NC 27262-3996
Phone
(336) 883-0029
NPI assigned
Feb 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Authorized official

Name
Lenin J Peters, MDNPI 1083638860
Title
Ceo
Phone
(336) 883-0029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

819 N Main St Ste 112
High Point, NC 27262-3996

Mailing address

507 N Lindsay St
High Point, NC 27262-4303
Phone (336) 883-0029

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013000729 NC Part B Supplier - Clinic/Group Practice 4486614575 Receives reassigned benefits from 88 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: High Point, NC; Winston Salem, NC; North Wilkesboro, NC; Mount Airy, NC; Kernersville, NC; Jamestown, NC; Greensboro, NC

National Provider Directory

National Provider Directory
Tax ID family
Agha Khan MD7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1007 Liberty Rd
Archdale, NC 27263
Phone (336) 431-3424

507 N Lindsay St
High Point, NC 27262

1580 Skeet Club Rd
Fl 3
High Point, NC 27265

108 W Main St
Ste E
Jamestown, NC 27282

495 Arbor Hill Rd
Ste M
Kernersville, NC 27284

190 Independence Ave
Ste B
North Wilkesboro, NC 28659
Phone (336) 289-2289

575 N Patterson Ave
Ste 440
Winston Salem, NC 27101
Phone (877) 722-8910

Ownership & related parties

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 73

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1508459306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N LINDSAY ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272624303",
            "telephone_number": "336-883-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 N MAIN ST STE 112",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272623996",
            "telephone_number": "336-883-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY MEDICAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-12",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "LENIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-883-0029",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.