NPIMap

Organization Active NPI

Triad Adult and Pediatric Medicine, Inc.

  • Federally Qualified Health Center (FQHC)
  • High Point, NC
National Provider Identifier
1629077490
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Practice address
400 E Commerce Ave
High Point, NC 27260-5221
Phone
(336) 884-0224
Fax
(336) 884-3471
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

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

Authorized official

Name
Mr. Brian K. Ellerby, MSPH CMPE
Title
Chief Executive Officer
Phone
(336) 272-1050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

400 E Commerce Ave
High Point, NC 27260-5221

Mailing address

1046 E Wendover Ave
Greensboro, NC 27405-6712
Phone (336) 272-1050

Other identifiers 4

IdentifierTypeStateIssuer
890245JMedicaidNC
34D0926775OtherCLIA
0272JOtherNCBCBS
2318638AOtherNCMEDICARE PART B

Other names 1

  • Guilford Child Health-High Point Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1629077490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056712",
            "telephone_number": "336-272-1050",
            "fax_number": "336-272-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E COMMERCE AVE",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272605221",
            "telephone_number": "336-884-0224",
            "fax_number": "336-884-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD ADULT AND PEDIATRIC MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "ELLERBY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "336-272-1050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPH CMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890245J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34D0926775",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0272J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "2318638A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guilford Child Health-High Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.