Individual provider Active NPI

Michael Elliott Harris, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1659510832
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-01721 Issued in NC
Practice address
190 Kimel Park Dr # 155
Winston Salem, NC 27103-6946
Phone
(336) 765-6637
Fax
(336) 765-6964
NPI assigned
Feb 12, 2009
Last updated
Nov 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-01721 NC Primary
Medical Physician Assistant 363AM0700X 0010-01721 NC

Addresses

Primary practice location

190 Kimel Park Dr # 155
Winston Salem, NC 27103-6946

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

5175 Old Clemmons School Rd
Clemmons, NC 27012-9087
Phone (336) 716-2255

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
I20090519000690 NC Practitioner - Physician Assistant 7012066178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

152 E Kinderton Way
Suite 101
Bermuda Run, NC 27006-7351
Phone (336) 893-3210

190 Kimel Park Dr
Winston Salem, NC 27103-6946

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 277-1717

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-01721NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Nov 4, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 4, 2023 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Marlette Family Practice, PA Past Accepting new patients

Locations

5175 Old Clemmons School Rd
Clemmons, NC 27012
Phone (336) 718-3960

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: mharris1164411@direct.novanthealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1659510832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR # 155",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-6637",
            "fax_number": "336-765-6964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5175 Old Clemmons School Rd",
            "address_purpose": "LOCATION",
            "city": "Clemmons",
            "state": "NC",
            "postal_code": "270129087",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "fax_number": "336-940-2561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MICHAEL",
        "middle_name": "ELLIOTT",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-12",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01721",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-01721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.