Individual provider Active NPI

Alexei Radiontchenko, MD

  • Family Medicine Physician
  • Kernersville, NC
National Provider Identifier
1619993946
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9801455 Issued in NC
Practice address
291 Broad St
Kernersville, NC 27284-2932
Phone
(336) 993-8181
Fax
(336) 996-9539
NPI assigned
Jul 13, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9801455 NC Primary

Addresses

Primary practice location

291 Broad St
Kernersville, NC 27284-2932

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 993-8181

Other identifiers 3

IdentifierTypeStateIssuer
1189COtherNCBCBS - CATAWBA
G91367OtherNCUPIN
891189CMedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aradiontchenko5381@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
I20080422000837 NC Practitioner - Family Practice 6608954276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

291 Broad St
Kernersville, NC 27284-2932
Phone (336) 993-8181

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9801455NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. Family Medicine Current Accepting new patients
Forsyth Memorial Hospital, Inc Family Medicine CurrentSince Apr 1, 2008 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Apr 1, 2008 Accepting new patients
Forsyth Memorial Hospital, Inc Family Medicine Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

7607 NC Highway 68 N
Ste B
Oak Ridge, NC 27310
Phone (336) 643-3378

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

Organizations & group practices 4

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 3

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1619993946",
    "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": "336-993-8181",
            "fax_number": "336-996-9539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 BROAD ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842932",
            "telephone_number": "336-993-8181",
            "fax_number": "336-996-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADIONTCHENKO",
        "first_name": "ALEXEI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2023-03-07",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9801455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - CATAWBA",
            "identifier": "1189C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "G91367",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891189C",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aradiontchenko5381@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "291 Broad St",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.