NPIMap

Individual provider Active NPI

Suzanne Michelle Gerald, FNP-C

  • Nurse Practitioner
  • Clemmons, NC
National Provider Identifier
1609584143
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5017247 Issued in NC
Practice address
2341 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone
(336) 713-2121
Fax
(336) 716-3065
NPI assigned
Nov 14, 2022
Last updated
Dec 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5017247 NC Primary
Family Nurse Practitioner 363LF0000X 5017247 NC
Registered Nurse 163W00000X 231867 NC

Addresses

Primary practice location

2341 Lewisville Clemmons Rd
Clemmons, NC 27012-8905

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-0238

Other practice location 1

Medical Center Blvd
Winston Salem, NC 27157-8905
Phone (336) 716-4081

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230120001260 NC Practitioner - Nurse Practitioner 1254702780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oandw EnterprisesGroup PAC ID 6608927298, 216 clinicians

Practice addresses (Care Compare)

935 Fairystone Park Hwy
Stanleytown, VA 24168-3014
Phone (888) 724-0268

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5017247NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Dec 19, 2022 Accepting new patients
North Carolina Baptist Hospital PastSince Nov 1, 2022 Accepting new patients

Locations

2341 Lewisville Clemmons Rd
Clemmons, NC 27012
Phone (336) 713-2121

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: sgerald2753652@carolinashealthcaresystem.direct-ci.com

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1609584143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-716-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 LEWISVILLE CLEMMONS RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128905",
            "telephone_number": "336-713-2121",
            "fax_number": "336-716-3065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271578905",
            "country_code": "US",
            "telephone_number": "336-716-4081",
            "fax_number": "336-716-3065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GERALD",
        "first_name": "SUZANNE",
        "middle_name": "MICHELLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-14",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5017247",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5017247",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "231867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

Verify at the official NPI Registry.