Active NPI
Milan Petrovic
- Family Medicine Physician
- Winston Salem, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2013-01383
- Practice address
- 250 Charlois Blvd
Winston Salem, NC 27103-1508 - Phone
- (336) 718-1000
- Fax
- (336) 718-1052
- NPI assigned
- Sep 28, 2010
- Last updated
- Oct 25, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2013-01383 | NC | Primary |
Addresses
Primary practice location
250 Charlois Blvd
Winston Salem, NC 27103-1508
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-1000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mpetrovic43883@direct.novanthealth.org |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
120 Healthplex Way
Apex, NC 27502-8403
Phone (919) 350-0550
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013-01383 | NC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Specialty Physicians, LLC | Family Medicine | Current | Accepting new patients |
| Wake Specialty Physicians LLC | Current | Accepting new patients | |
| Wake Specialty Physicians, LLC | Family Medicine | Current | Accepting new patients |
Locations
120 Healthplex Way
Apex, NC 27502
Phone (919) 350-0550
110 Kildaire Park Dr
Cary, NC 27518
Phone (919) 235-0616
7560 Carpenter Fire Station Rd
Cary, NC 27519
Phone (919) 235-6545
10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300
10000 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1630
Interoperability endpoints
- mpetrovic348093@directhisp.wakemed.org
- mpetrovic43883@direct.novanthealth.org
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba WakeMed Childrens Pediatric Primary Care - Fuquay-Varina Medical Park
- Pediatrics Physician
- Fuquay Varina, NC
- NPI 1578334892
-
dba WakeMed Physician Practices Primary Care Apex
- Family Medicine Physician
- Apex, NC
- NPI 1215348156
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba WakeMed Mental Health & Well-Being Hospital WakeBrook
- Psychiatric Hospital Unit
- Raleigh, NC
- NPI 1780446302
-
- Home Health Agency
- Raleigh, NC
- NPI 1811998990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603584000000",
"number": "1588973341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803",
"telephone_number": "336-718-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 CHARLOIS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031508",
"telephone_number": "336-718-1000",
"fax_number": "336-718-1052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROVIC",
"first_name": "MILAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-28",
"last_updated": "2020-10-25",
"certification_date": "2020-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "2013-01383",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mpetrovic43883@direct.novanthealth.org",
"affiliation": "N",
"address_1": "250 Charlois Blvd",
"city": "Winston Salem",
"state": "NC",
"country_code": "US",
"postal_code": "271031508",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.