Wake Forest Health Network LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

WAKE FOREST HEALTH NETWORK LLC

Doing business as

Pinewest OB-Gyn at Premier

Practice address

4515 Premier Dr
Suite 405
High Point, NC 27265-8357

Phone

(336) 885-0149

Fax

(336) 885-2933

NPI assigned

May 28, 2013

Last updated

Sep 2, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Russell Mars Howerton, MD

Title

Sr VP Network Phys & HS Cmo

Phone

(336) 716-1331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pinewest OB-Gyn at Premier Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary George Poehling, MD

  • Orthopaedic Surgery Physician
  • Winston Salem, NC
  • NPI 1437133816
  NPD
• Jill M Wagner, MD

  • Obstetrics & Gynecology Physician
  • High Point, NC
  • NPI 1023097516
  NPD

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

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1659718922",
    "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",
            "fax_number": "336-716-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 PREMIER DR",
            "address_2": "SUITE 405",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272658357",
            "telephone_number": "336-885-0149",
            "fax_number": "336-885-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST HEALTH NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-28",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "HOWERTON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "MARS",
        "authorized_official_title_or_position": "SR VP NETWORK PHYS & HS CMO",
        "authorized_official_telephone_number": "336-716-1331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913500",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinewest OB-Gyn at Premier",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pinewest OB-Gyn at Premier",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Obstetrics & Gynecology Physician in High Point, NC
• Providers in High Point, NC by specialty
• Obstetrics & Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.