Individual provider Active NPI

Archie A. Tyson, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • High Point, NC
National Provider Identifier
1629039862
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
29432 Issued in NC
Practice address
1226 Eastchester Dr Ste 100
High Point, NC 27265-3116
Phone
(336) 481-8540
Fax
(336) 481-8549
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 29432 NC
Clinical Cardiac Electrophysiology Physician 207RC0001X 29432 NC Primary

Addresses

Primary practice location

1226 Eastchester Dr Ste 100
High Point, NC 27265-3116

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 996-7076

Other practice location 1

306 Westwood Ave
Suite 401
High Point, NC 27262-4341
Phone (336) 885-6168

Other practice location 2

1710 Kernersville Medical Pkwy Ste 205
Kernersville, NC 27284-7156
Phone (336) 996-7076

Other identifiers 2

IdentifierTypeStateIssuer
8984446MedicaidNC
P00654540OtherNCRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address atyson205802@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
I20040911000054 NC Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 7618944562 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1622 Highwoods Blvd
Unit G105
Greensboro, NC 27410-2048
Phone (336) 660-5200

1710 Kernersville Medical Pkwy
Suite 205
Kernersville, NC 27284-7156
Phone (336) 983-4500

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Thomasville Medical Center Hospital, Thomasville, NC, CCN 340085

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting25
Pacemaker insertion or repair22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Novant Health Ballantyne Medical Center LLC CurrentSince Sep 19, 2023 Accepting new patients
Novant Health Thomasville Medical Center LLC CurrentSince Oct 26, 2023 Accepting new patients
Cornerstone Health Care PA Cardiovascular Disease CurrentSince Oct 1, 2008 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients
Forsyth Memorial Hospital Inc Cardiovascular Disease CurrentSince May 1, 2020 Accepting new patients
Novant Health Medical Group, LLC Cardiovascular Disease CurrentSince Dec 20, 2020 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Oct 1, 2008 Accepting new patients
Forsyth Memorial Hospital, Inc. Cardiovascular Disease CurrentSince May 1, 2020 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Cardiovascular Disease CurrentSince May 1, 2020 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jul 18, 2020 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Novant Health Mint Hill Medical Center, LLC CurrentSince Jul 18, 2020 Accepting new patients
Novant Health Thomasville Medical Center, LLC CurrentSince Oct 26, 2023 Accepting new patients
Cornerstone Health Care PA Cardiovascular Disease Past Accepting new patients
Carolina Regional Heart Center Past Accepting new patients
High Point Regional Health Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

125 Baldwin Ave
Ste 200
Charlotte, NC 28204
Phone (704) 384-5043

8201 Healthcare Loop
Charlotte, NC 28215
Phone (980) 302-1000

10905 Providence Rd W
Charlotte, NC 28277
Phone (980) 488-4000

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

189 Samaritans Ridge Rd
Elkin, NC 28621
Phone (336) 526-3003

1622 Highwoods Blvd
Unit G105
Greensboro, NC 27410
Phone (336) 660-5200

1226 Eastchester Dr
#100
High Point, NC 27265
Phone (336) 481-8540

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

306 Westwood Ave
Ste 401
High Point, NC 27262
Phone (336) 885-6168

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

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

1710 Kernersville Medical Pkwy
Ste 205
Kernersville, NC 27284
Phone (336) 983-4500

694 Riverside Dr
Mount Airy, NC 27030
Phone (336) 719-7892

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

1219 Lexington Ave
Ste C
Thomasville, NC 27360
Phone (336) 475-5337

211 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-1191

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

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

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 2

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1629039862",
    "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": "336-996-7076",
            "fax_number": "336-996-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 EASTCHESTER DR STE 100",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272653116",
            "telephone_number": "336-481-8540",
            "fax_number": "336-481-8549"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "306 Westwood Ave",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272624341",
            "country_code": "US",
            "telephone_number": "336-885-6168",
            "fax_number": "336-885-8523",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1710 Kernersville Medical Pkwy Ste 205",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272847156",
            "country_code": "US",
            "telephone_number": "336-996-7076",
            "fax_number": "336-996-7832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYSON",
        "first_name": "ARCHIE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "29432",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NC",
            "license": "29432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8984446",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00654540",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "atyson205802@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "306 Westwood Ave",
            "address_2": "Suite 401",
            "city": "High Point",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272624341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

Verify at the official NPI Registry.