NPIMap

Individual provider Active NPI

Jerry Lamon Powell, MD

  • Hospitalist Physician
  • Winston Salem, NC
National Provider Identifier
1669405536
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
9900991 Issued in NC
Practice address
3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone
(336) 718-8383
Fax
(336) 718-9622
NPI assigned
Jul 7, 2006
Last updated
May 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0099-00991 NC
Hospitalist Physician 208M00000X 9900991 NC Primary

Addresses

Primary practice location

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 564-4866

Other practice location 1

1750 Kernersville Medical Pkwy
Kernersville, NC 27284-7146
Phone (336) 564-4866

Other identifiers 2

IdentifierTypeStateIssuer
110245714OtherNCRR MEDICARE
891238CMedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpowell515607@direct.novanthealth.org

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
I20050405001152 NC Practitioner - Internal Medicine 1557318185 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Brody School of Medicine at East Carolina University, 1999
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)

1750 Kernersville Med PK
Kernersville, NC 27284-7146
Phone (336) 564-4727

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0099-00991NCMDInternal Medicine Physician
9900991NCMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Mar 1, 2003 Accepting new patients
Novant Health Medical Group, LLC Internal Medicine CurrentSince Oct 1, 2017 Accepting new patients
Wake Forest Health Network LLC CurrentSince Mar 1, 2003 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Oct 1, 2017 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest University Health Sciences PastSince Mar 1, 2015 Accepting new patients
East Carolina Health-Bertie Past Accepting new patients

Locations

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

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

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

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

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Interoperability endpoints

  • Direct secure messaging: jpowell80331@direct.unc.nchie.net

Organizations & group practices 8

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 9

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1669405536",
    "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",
            "telephone_number": "336-564-4866",
            "fax_number": "336-564-4869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "336-718-8383",
            "fax_number": "336-718-9622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 Kernersville Medical Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272847146",
            "country_code": "US",
            "telephone_number": "336-564-4866",
            "fax_number": "336-564-4869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POWELL",
        "first_name": "JERRY",
        "middle_name": "LAMON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "0099-00991",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "9900991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110245714",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891238C",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpowell515607@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1750 Kernersville Medical Pkwy",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272847146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.