Triad Adult and Pediatric Medicine, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Doing business as

Guilford Child Health-Wendover

Practice address

1046 E Wendover Ave
Greensboro, NC 27405-6712

Phone

(336) 272-1050

Fax

(336) 272-0155

NPI assigned

Jun 30, 2005

Last updated

Aug 29, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Brian K Ellerby, MSPH CMPE

Title

Chief Executive Officer

Phone

(336) 272-1050

Specialties & licenses 1

Addresses

Other names 1

• Guilford Child Health-Wendover Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598762940. Details of each certification follow.

• CCN 341966 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 341966

Legal name

TRIAD ADULT AND PEDIATRIC MEDICINE INC

Doing business as

PEDIATRICS AT WENDOVER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 17, 2011

Last certification

Nov 17, 2011

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 13, 2010 in NC

Enrollment address

1046 E Wendover Ave
Greensboro, NC 27405-6712

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Triad Adult and Pediatric Medicine, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greensboro, NC
  • NPI 1063712727

  1850311986

  Same PAC ID
• Triad Adult and Pediatric Medicine, Inc.

  dba Family Medicine at Northwood

  • Federally Qualified Health Center (FQHC)
  • Greensboro, NC
  • NPI 1447980883

  1850311986

  Same PAC ID
• Triad Adult and Pediatric Medicine, Inc.

  • Federally Qualified Health Center (FQHC)
  • High Point, NC
  • NPI 1528720653

  1850311986

  Same PAC ID
• Triad Adult and Pediatric Medicine, Inc.

  dba Family Medicine at Arlington Street

  • Family Medicine Physician
  • Greensboro, NC
  • NPI 1881059723

  1850311986

  Same PAC ID
• Triad Adult and Pediatric Medicine, Inc.

  dba TAPM Family Medicine at Brentwood

  • Federally Qualified Health Center (FQHC)
  • High Point, NC
  • NPI 1972050979

  1850311986

  Same PAC ID

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Triad Adult and Pediatric Medicine, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greensboro, NC
  • NPI 1063712727

  Operational/Managerial Control

  CMS ownership

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1598762940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056712",
            "telephone_number": "336-272-1050",
            "fax_number": "336-272-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056712",
            "telephone_number": "336-272-1050",
            "fax_number": "336-272-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD ADULT AND PEDIATRIC MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "ELLERBY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "336-272-1050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPH CMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guilford Child Health-Wendover",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Triad Adult and Pediatric Medicine, Inc. (TAPM Family Medicine at East Market Street)
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc. (HealthServe North East)
• Triad Adult and Pediatric Medicine, Inc. (Family Medicine at Northwood)
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc. (Guilford Child Health-Spring Valley)
• Triad Adult and Pediatric Medicine, Inc. (Family Medicine at Arlington Street)
• Triad Behavioral Resources

• Federally Qualified Health Center (FQHC) in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Federally Qualified Health Center (FQHC) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.