Individual provider Active NPI

Joseph Mathis

  • Occupational Therapist
  • Winston Salem, NC
National Provider Identifier
1639882053
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
15556 Issued in NC
Practice address
170 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone
(336) 765-7058
NPI assigned
Dec 30, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 15556 NC Primary

Addresses

Primary practice location

170 Kimel Park Dr
Winston Salem, NC 27103-6946

Mailing address

4601 Park Rd Ste 300
Charlotte, NC 28209-2290
Phone (704) 323-3611

Other practice location 1

170 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone (336) 765-7058

Other identifiers 1

IdentifierTypeStateIssuer
0397730042OtherNCNSC#

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230113002082 NC Practitioner - Occupational Therapist in Private Practice 5698146439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2718 Henry St
Greensboro, NC 27405-3633
Phone (336) 375-1007

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15556NCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocarolina Occupational Therapist CurrentSince Jan 9, 2023 Accepting new patients
Wake Forest University Health Sciences Occupational Therapist CurrentSince Feb 6, 2025 Accepting new patients
Orthocarolina Occupational Therapist CurrentSince Jan 9, 2023 Accepting new patients

Locations

4601 Park Rd
Ste 300
Charlotte, NC 28209
Phone (704) 323-2090

1915 Randolph Rd
Charlotte, NC 28207
Phone (704) 339-1000

2718 Henry St
Greensboro, NC 27405
Phone (336) 375-1007

861 Old Winston Rd
Kernersville, NC 27284
Phone (336) 713-3500

170 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 765-7058

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1672358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1639882053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092290",
            "telephone_number": "704-323-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 KIMEL PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-7058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Kimel Park Dr",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271036946",
            "country_code": "US",
            "telephone_number": "336-765-7058",
            "fax_number": "336-346-2152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JOSEPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-30",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "15556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC#",
            "identifier": "0397730042",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.