NPIMap

Organization Active NPI

Moses Cone Affiliated Physicians, Inc.

  • Family Medicine Physician
  • Kernersville, NC
National Provider Identifier
1699196295
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9500628 Issued in NC
Legal business name
MOSES CONE AFFILIATED PHYSICIANS, INC.
Practice address
1617 NC Highway 66 S
Suite 101
Kernersville, NC 27284-3828
Phone
(336) 993-2224
NPI assigned
Dec 27, 2013
Organization subpart
Yes
Parent organization
THE MOSES H. CONE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
Sally Hammond
Title
Executive Director
Phone
(336) 663-5007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 9500628 NC Primary

Addresses

Primary practice location

1617 NC Highway 66 S
Suite 101
Kernersville, NC 27284-3828

Mailing address

PO Box 745032
Atlanta, GA 30374-5032
Phone (888) 563-3282

Other names 1

  • Piedmont Triad Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000512 NC Part B Supplier - Clinic/Group Practice 3779635396 Receives reassigned benefits from 86 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Reidsville, NC; Oak Ridge, NC; Kernersville, NC; High Point, NC; Burlington, NC; Asheboro, NC

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

National Provider Directory

National Provider Directory
Part of
Moses Cone Mem Hosp

NPI Registry JSON

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

{
    "created_epoch": "1388102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1699196295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745032",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303745032",
            "telephone_number": "888-563-3282",
            "fax_number": "605-677-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 NC HIGHWAY 66 S",
            "address_2": "SUITE 101",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272843828",
            "telephone_number": "336-993-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES CONE AFFILIATED PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MOSES H. CONE MEMORIAL HOSPITAL",
        "enumeration_date": "2013-12-27",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-663-5007"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9500628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Triad Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.