NPIMap

Organization Active NPI

Bethany Medical Center

  • Anatomic Pathology & Clinical Pathology Physician
  • Kernersville, NC
National Provider Identifier
1619398997
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
BETHANY MEDICAL CENTER
Practice address
495 Arbor Hill Rd Ste M
Kernersville, NC 27284-3335
Phone
(336) 883-0029
NPI assigned
Jan 3, 2014
Last updated
Oct 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BETHANY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Authorized official

Name
Lenin J Peters, M.D.NPI 1083638860
Title
President/Ceo
Phone
(336) 883-0029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X NC
Anatomic Pathology Physician 207ZP0101X NC
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NC Primary

Addresses

Primary practice location

495 Arbor Hill Rd Ste M
Kernersville, NC 27284-3335

Mailing address

507 N Lindsay St
High Point, NC 27262-4303
Phone (336) 883-0029

Other practice location 1

302 Lindsay St
Second Floor
High Point, NC 27262
Phone (336) 883-0029 ext. 268

Other identifiers 4

IdentifierTypeStateIssuer
3409940MedicaidNC
5907644MedicaidNC
7901101MedicaidNC
89011F1MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013000729 NC Part B Supplier - Clinic/Group Practice 4486614575 Receives reassigned benefits from 88 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: High Point, NC; Winston Salem, NC; North Wilkesboro, NC; Mount Airy, NC; Kernersville, NC; Jamestown, NC; Greensboro, NC

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Part of
Bethany Medical Ctr PA

Locations

302 Lindsay St
Fl Second
High Point, NC 27262
Phone 3368830029 ext. 268

Practitioners & affiliated clinicians

Practitioners 144

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 144

NPI Registry JSON

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

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1619398997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 N LINDSAY ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272624303",
            "telephone_number": "336-883-0029",
            "fax_number": "336-899-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 ARBOR HILL RD STE M",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272843335",
            "telephone_number": "336-883-0029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 Lindsay St",
            "address_2": "Second Floor",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "27262",
            "country_code": "US",
            "telephone_number": "336-883-0029 x268",
            "fax_number": "336-899-2188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BETHANY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETHANY MEDICAL CENTER",
        "enumeration_date": "2014-01-03",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "LENIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "336-883-0029",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409940",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907644",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901101",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011F1",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.