Individual provider Active NPI

Michelle Chidester Linkous, D.O.

  • Pediatrics Physician
  • King, NC
National Provider Identifier
1598925166
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2011-00534 Issued in NC
Practice address
167 Moore Rd Ste 201
King, NC 27021-8770
Phone
(336) 673-6470
Fax
(336) 673-6489
NPI assigned
Jun 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2011-00534 NC Primary

Addresses

Primary practice location

167 Moore Rd Ste 201
King, NC 27021-8770

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

1351 Westgate Center Dr
Winston Salem, NC 27103-2934
Phone (336) 718-7777

Other practice location 2

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 716-2255

Other identifiers 1

IdentifierTypeStateIssuer
5918174MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mlinkous155185@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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110915000874 NC Practitioner - Pediatric Medicine 1355512716 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2011-00534NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Dec 1, 2021 Accepting new patients
Novant Health Medical Group, LLC Pediatrics CurrentSince Dec 1, 2021 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

167 Moore Rd
Ste 201
King, NC 27021
Phone (336) 673-6450

1351 Westgate Center Dr
Winston Salem, NC 27103
Phone (336) 718-7777

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1598925166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 MOORE RD STE 201",
            "city": "KING",
            "state": "NC",
            "postal_code": "270218770",
            "telephone_number": "336-673-6470",
            "fax_number": "336-673-6489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1351 Westgate Center Dr",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271032934",
            "country_code": "US",
            "telephone_number": "336-718-7777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2311 Lewisville Clemmons Rd",
            "address_purpose": "LOCATION",
            "city": "Clemmons",
            "state": "NC",
            "postal_code": "270128905",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LINKOUS",
        "first_name": "MICHELLE",
        "middle_name": "CHIDESTER",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-16",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2011-00534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5918174",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlinkous155185@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "2311 Lewisville Clemmons Rd",
            "city": "Clemmons",
            "state": "NC",
            "country_code": "US",
            "postal_code": "270128905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in King, NC

Sources for this page

Verify at the official NPI Registry.