Active NPI
Charles Fredric Reid, M.D.
- Urology Physician
- Winston-Salem, NC
National Provider Identifier
1659333433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 22963
- Practice address
- 140 Kimel Park Dr
Winston-Salem, NC 27103-6946 - Phone
- (336) 245-2100
- Fax
- (336) 768-7782
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 22963 | NC | Primary |
Addresses
Primary practice location
140 Kimel Park Dr
Winston-Salem, NC 27103-6946
Mailing address
140 Kimel Park Dr
Winston-Salem, NC 27103-6946
Phone (336) 245-2100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2344759 | Other | NC | MEDICARE, GROUP |
| 8971092 | Medicaid | NC | |
| 340019145 | Other | NC | RR MEDICARE |
| 209867B | Other | NC | MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22963 | NC | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371772800000",
"number": "1659333433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 KIMEL PARK DR",
"city": "WINSTON-SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-245-2100",
"fax_number": "336-768-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 KIMEL PARK DR",
"city": "WINSTON-SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-245-2100",
"fax_number": "336-768-7782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REID",
"first_name": "CHARLES",
"middle_name": "FREDRIC",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2013-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NC",
"license": "22963",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE, GROUP",
"identifier": "2344759",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8971092",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "340019145",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "209867B",
"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 Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.