Triad Center for Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

TRIAD CENTER FOR SURGERY

Doing business as

Kimel Park Surgery Center

Practice address

180 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6970

Phone

(202) 378-0139

NPI assigned

May 10, 2020

Organization subpart

No

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

Authorized official

Name

William Montgomery

Title

President

Phone

(615) 545-9132

Specialties & licenses 1

Addresses

Other names 1

• Kimel Park Surgery Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Triad Center for Surgery Dba Kimel Park Surgery CenterCCN 34C0001215

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Harlan Beaver Daubert, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Winston Salem, NC
  • NPI 1356306922
  NPD (past)

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

{
    "created_epoch": "1589068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1558983833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 KIMEL PARK DR STE 200",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036970",
            "telephone_number": "336-607-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 KIMEL PARK DR STE 200",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036970",
            "telephone_number": "202-378-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD CENTER FOR SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-10",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-545-9132"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kimel Park Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kimel Park Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bailey Allyson Trent, PHARMD
• Harley Eugene Trero, OTA/L
• Lori Trexler, M.S., OTR
• Tri Star LLC.
• Tri-Care, PA
• Triad Choice Pharmacy (Triad Choice Pharmacy LLC)
• Triad Choice Pharmacy
• Triad Cornea Community
• Triad Dermatology PA
• Triad Geriatric Care LLC

• Ambulatory Surgical Clinic/Center in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.