NPIMap

Individual provider Active NPI

Eswara Moorthy Sellamuthu

  • Diagnostic Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1649923293
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2024-01258 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-4330
Phone
(336) 716-7243
Fax
(336) 716-7432
NPI assigned
Feb 2, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R79173 AZ
Diagnostic Radiology Physician 2085R0202X 2024-01258 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-4330

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-7243

Other practice location 1

1625 N Campbell Ave Fl 2
Tucson, AZ 85719-4330
Phone (520) 288-3431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241114004478 NC Practitioner - Diagnostic Radiology 5597299305 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLC 276 clinicians
Wake Forest Baptist Imaging LLC 76 clinicians
Wake Forest University Health Sciences 2,633 clinicians

Practice addresses (Care Compare)

223 W Ward St
Suite B
Asheboro, NC 27203-5423
Phone (336) 625-4215

265 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • High Point Regional Health System Hospital, High Point, NC, CCN 340004
  • Wilkes Regional Medical Center Hospital, North Wilkesboro, NC, CCN 340064
  • Hugh Chatham Memorial Hospital Hospital, Elkin, NC, CCN 340097
  • Watauga Medical Center Hospital, Boone, NC, CCN 340051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R79173AZMDDiagnostic Radiology Physician
2024-01258NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Sep 1, 2025 Accepting new patients
Wake Forest University Health Sciences CurrentSince Sep 23, 2024 Accepting new patients
Wake Forest Health Network LLC CurrentSince Sep 1, 2025 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Oct 1, 2024 Accepting new patients
Wake Forest Baptist Imaging, LLC Diagnostic Radiology CurrentSince Oct 1, 2024 Accepting new patients
Wake Forest Baptist Imaging LLC Diagnostic Radiology CurrentSince Sep 27, 2024 Accepting new patients

Locations

223 W Ward St
#B
Asheboro, NC 27203

223 W Ward St
Ste B
Asheboro, NC 27203
Phone (336) 702-1731

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

1814 Westchester Dr
Ste 402
High Point, NC 27262
Phone (336) 802-5505

861 Old Winston Rd
Ste 105
Kernersville, NC 27284
Phone (336) 765-5722

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

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

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

Interoperability endpoints

  • Direct secure messaging: esellamuthu2756146@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 24

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 24

Hospital & facility affiliations 10

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": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1649923293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-7243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271574330",
            "telephone_number": "336-716-7243",
            "fax_number": "336-716-7432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 N Campbell Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857194330",
            "country_code": "US",
            "telephone_number": "520-288-3431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SELLAMUTHU",
        "first_name": "ESWARA",
        "middle_name": "MOORTHY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-02",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "R79173",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2024-01258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.