NPIMap

Organization Active NPI

Wake Forest University Baptist Medical Center Community Physicians

Doing business as Mocksville Pediatrics

  • Pediatrics Physician
  • Mocksville, NC
National Provider Identifier
1568455707
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Doing business as
Mocksville Pediatrics
Practice address
113 Marketplace Drive
Mocksville, NC 27028
Phone
(336) 753-8244
Fax
(336) 753-8248
NPI assigned
Aug 23, 2005
Last updated
Apr 10, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Authorized official

Name
Mr. Lewis S Thorp III
Title
President Ceo
Phone
(336) 721-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NC Primary

Addresses

Primary practice location

113 Marketplace Drive
Mocksville, NC 27028

Mailing address

113 Marketplace Drive
Mocksville, NC 27028
Phone (336) 753-8244

Other identifiers 2

IdentifierTypeStateIssuer
2317728ROtherNCMEDICARE GROUP NUMBER
89015YHMedicaidNC

Other names 1

  • Mocksville Pediatrics Doing business as

National Provider Directory

National Provider Directory
Part of
Winston East OB GYN

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1568455707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MARKETPLACE DRIVE",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "27028",
            "telephone_number": "336-753-8244",
            "fax_number": "336-753-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 MARKETPLACE DRIVE",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "27028",
            "telephone_number": "336-753-8244",
            "fax_number": "336-753-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "enumeration_date": "2005-08-23",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "THORP",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "336-721-3900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728R",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015YH",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mocksville Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mocksville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.