Julian Michael Bridges, LCSW – Clinical Social Worker

Key facts

NPI: 1699863050
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: C005454 (NC)
Practice address: 1001 Reynolda Rd
Winston Salem, NC 27104-3245
Phone: (336) 721-7657
Fax: (336) 728-4355
NPI assigned: Oct 11, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

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.

Triumph LLC Clinical Social Worker · Raleigh, NC · NPI 1003961269

NPD (past) CLINICAL

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
C005454	NC	MD	Clinical Social Worker
005454	NC	MD	Certified Registered Nurse Anesthetist

Practice roles

Organization	Specialty	Status	New patients
Triumph LLC	Clinical	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	C005454	NC	Yes

Addresses

Primary practice location

1001 Reynolda Rd
Winston Salem, NC 27104-3245

Mailing address

3104 Hickory Ridge Dr
Winston Salem, NC 27127-4947

Other identifiers

Identifier	Type	State	Issuer
6106473	Medicaid	NC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2007.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1699863050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 HICKORY RIDGE DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271274947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 REYNOLDA RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043245",
            "telephone_number": "336-721-7657",
            "fax_number": "336-728-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGES",
        "first_name": "JULIAN",
        "middle_name": "MICHAEL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106473",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

All providers in Winston Salem, NC · Clinical Social Worker in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.