Individual provider Active NPI

Johanna De Jesus Mena Rosas, NP

  • Nurse Practitioner
  • Asheboro, NC
National Provider Identifier
1639817372
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5018721 Issued in NC
Practice address
138 Dublin Square Rd Ste C
Asheboro, NC 27203-8601
Phone
(336) 625-3333
Fax
(336) 626-8233
NPI assigned
May 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5018721 NC Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

138 Dublin Square Rd Ste C
Asheboro, NC 27203-8601

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-1331

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231031000977 NC Practitioner - Nurse Practitioner 2860848637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

138 Dublin Square Rd
Suite C
Asheboro, NC 27203-8601
Phone (336) 625-3333

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.3 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5018721NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network LLC CurrentSince Sep 25, 2023 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network, LLC CurrentSince Sep 25, 2023 Accepting new patients
Wake Forest Health Network LLC Past Accepting new patients
Cornerstone Health Care LLC Past Accepting new patients

Locations

223 W Ward St
#B
Asheboro, NC 27203

138 Dublin Square Rd
Ste C
Asheboro, NC 27203
Phone (336) 625-3333

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

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

Interoperability endpoints

  • Direct secure messaging: jmenarosas2753557@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1639817372",
    "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": "336-716-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 DUBLIN SQUARE RD STE C",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272038601",
            "telephone_number": "336-625-3333",
            "fax_number": "336-626-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENA ROSAS",
        "first_name": "JOHANNA",
        "middle_name": "DE JESUS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-23",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5018721",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheboro, NC

Sources for this page

Verify at the official NPI Registry.