Individual provider Active NPI

Evelyn Y Ofori, FNP

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1679191811
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5013690 Issued in NC
Practice address
730 Highland Oaks Dr
Winston Salem, NC 27103-7154
Phone
(336) 646-7323
Fax
(336) 646-7787
NPI assigned
Jul 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Nurse Practitioner 363L00000X 5013690 NC Primary

Addresses

Primary practice location

730 Highland Oaks Dr
Winston Salem, NC 27103-7154

Mailing address

PO Box 604050
Charlotte, NC 28260-4050

Other practice location 1

18 Oak Branch Dr Ste C
Greensboro, NC 27407-2444
Phone (336) 579-2312

Other names 1

  • Evelyn Y Bosompemaa Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eofori848748@direct.novanthealth.org

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
I20201120000325 NC Practitioner - Nurse Practitioner 5294146353 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5013690NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC Nurse Practitioner CurrentSince Dec 7, 2021 Accepting new patients
NH-CL Clinics, LLC CurrentSince Oct 30, 2020 Accepting new patients

Locations

18 Oak Branch Dr
Ste C
Greensboro, NC 27407
Phone (336) 579-2312

500 Pineview Dr
Ste 205
Kernersville, NC 27284
Phone (336) 310-6115

555 Fayetteville St
Raleigh, NC 27601
Phone (682) 268-1011

730 Highland Oaks Dr
Winston Salem, NC 27103
Phone (336) 646-7323

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: eofori848748@direct.novanthealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1679191811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604050",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 HIGHLAND OAKS DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271037154",
            "telephone_number": "336-646-7323",
            "fax_number": "336-646-7787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 Oak Branch Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274072444",
            "country_code": "US",
            "telephone_number": "336-579-2312",
            "fax_number": "336-579-2365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OFORI",
        "first_name": "EVELYN",
        "middle_name": "Y",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5013690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eofori848748@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "18 Oak Branch Dr Ste C",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274072444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EVELYN",
            "last_name": "BOSOMPEMAA",
            "middle_name": "Y",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.