Individual provider Active NPI

Jennifer Christine Parks, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1689683179
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2006-01163 Issued in NC
Practice address
105 Hanes Square Cir
Winston Salem, NC 27103-5514
Phone
(336) 441-5569
Fax
(336) 771-1907
NPI assigned
Aug 5, 2006
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2006-01163 NC
Family Medicine Physician 207Q00000X 2006-01163 NC Primary
Emergency Medicine Physician 207P00000X 200601163 NC

Addresses

Primary practice location

105 Hanes Square Cir
Winston Salem, NC 27103-5514

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-1000

Other practice location 1

250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone (336) 718-1000

Other identifiers 1

IdentifierTypeStateIssuer
2057165AMedicaidNC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jparks5443@direct.novanthealth.org
Direct Messaging Address jparks5443@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061106000445 NC Practitioner - Emergency MedicinePractitioner - Family Practice 6406853316 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of California, San Francisco School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

105 Hanes Square Cir
Winston Salem, NC 27103-5514
Phone (336) 441-5569

2452 Fairlawn CT
Winston Salem, NC 27106-3884
Phone (336) 281-5965

2635 Lawndale Dr
Greensboro, NC 27408-4802
Phone (336) 867-4310

3163 Gammon LN
Clemmons, NC 27012-9052
Phone (336) 310-5571

50 Miller St
Suite C
Winston Salem, NC 27104-4206
Phone (336) 310-5535

5870 Samet Dr
High Point, NC 27265-3646
Phone (336) 803-7311

600 Highland Oaks Dr
Winston Salem, NC 27103-7107
Phone (366) 774-0040

794 S Main St
Suite B
Kernersville, NC 27284-4074
Phone (336) 904-2317

910 E Innes St
Salisbury, NC 28144-4638
Phone (844) 266-8268

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006-01163NCMDEmergency Medicine Physician
200601163NCMDEmergency Medicine Physician
21246SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jul 26, 2023 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Dec 1, 2020 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Dec 1, 2020 Accepting new patients

Locations

349 New Leicester Hwy
Asheville, NC 28806
Phone (828) 412-0327

674 Merrimon Ave
Ste 101
Asheville, NC 28804
Phone (828) 348-7418

201 NC Highway 9
Black Mountain, NC 28711
Phone (828) 412-0327

114 S Sharon Amity Rd
Charlotte, NC 28211
Phone (980) 337-4428

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

8036 Providence Rd
Ste 100
Charlotte, NC 28277
Phone (980) 301-8711

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

3836 Corning Pl
Charlotte, NC 28216
Phone (704) 317-2108

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

445 S Kings Dr
Charlotte, NC 28204
Phone (704) 384-1734

5303 Poplar Tent Rd
Ste 90
Concord, NC 28027
Phone (980) 866-4493

2635 Lawndale Dr
Greensboro, NC 27408
Phone (336) 867-4310

5870 Samet Dr
High Point, NC 27265
Phone (336) 803-7311

794 S Main St
Ste B
Kernersville, NC 27284
Phone (336) 904-2317

1977 Cotton Grove Rd
Lexington, NC 27292
Phone (336) 243-3000

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

1122 Randolph St
Ste 110
Thomasville, NC 27360
Phone (336) 474-3433

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

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

105 Hanes Square Cir
Winston Salem, NC 27103
Phone (336) 441-5569

2452 Fairlawn Ct
Winston Salem, NC 27106
Phone (336) 281-5965

50 Miller St
Ste C
Winston Salem, NC 27104
Phone (336) 310-5535

Organizations & group practices 4

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1689683179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HANES SQUARE CIR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035514",
            "telephone_number": "336-441-5569",
            "fax_number": "336-771-1907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARKS",
        "first_name": "JENNIFER",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2006-01163",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2006-01163",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200601163",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2057165A",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jparks5443@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "250 Charlois Blvd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271031508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jparks5443@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "105 Hanes Square Cir",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271035514",
            "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.