Wake Forest Baptist Imaging, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WAKE FOREST BAPTIST IMAGING, LLC

Practice address

861 Old Winston Rd Ste 105
Kernersville, NC 27284-7141

Phone

(336) 765-5722

Fax

(336) 765-5723

NPI assigned

Sep 2, 2020

Organization subpart

Yes

Parent organization

WAKE FOREST BAPTIST IMAGING, LLCAs reported in NPPES

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

Authorized official

Name

Amy Stout

Title

President/Ceo

Phone

(615) 261-2306

Specialties & licenses 2

Addresses

Other names 1

• Atrium Health Wake Forest Baptist Imaging - Kernersville Doing business as

Medicare fee-for-service enrollment

Enrolled in NC, TN, FL, NY, NM, IN, CO, WI, TX9 enrollments

Enrollment records 9

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wake Forest Baptist Imaging LLC

  • Diagnostic Radiology Physician
  • Greensboro, NC
  • NPI 1841049913

  3173681681

  Same PAC ID
• Wake Forest Baptist Imaging, LLC

  • Radiology Clinic/Center
  • Winston Salem, NC
  • NPI 1972763357

  3173681681

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Wake Forest Baptist Imaging, LLC

  • Radiology Clinic/Center
  • Winston Salem, NC
  • NPI 1972763357

  O20081027000587, O20251030004608, O20251106000262, O20251128000277, O20251220000092, O20251223000694, O20260202003596, O20260226003713, O20260305000884

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Wake Forest Baptist Imaging3 organizations share this tax ID, including this one

Part of

Wake Forest Baptist Imaging

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Wake Forest Baptist Imaging LLC

  • Diagnostic Radiology Physician
  • Greensboro, NC
  • NPI 1841049913
  NPD tax ID
• Wake Forest Baptist Imaging, LLC

  • Radiology Clinic/Center
  • Winston Salem, NC
  • NPI 1972763357
  NPD tax ID

Locations

Practitioners 109

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaideep Shrinivas Joshi, MD

  • Diagnostic Radiology Physician
  • St Francis, WI
  • NPI 1972572592

  Diagnostic Radiology, WI

  Medicare reassignment NPD
• Mark Gerard Amirault, DO, MPH

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1356802441

  Diagnostic Radiology

  NPD
• Evelyn Young Anthony, MD

  • Pediatric Radiology Physician
  • Winston Salem, NC
  • NPI 1225014491
  NPD
• Michael D Baker, MD

  • Neuroradiology Physician
  • Winston Salem, NC
  • NPI 1972588523
  NPD
• Hayden Presley Barrett, MD

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1467075606

  Diagnostic Radiology

  NPD
• Marc Benayoun, M.D., PH.D.

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1790041861

  Diagnostic Radiology

  NPD
• Angela Paige Bennett, MD

  • Nuclear Radiology Physician
  • Winston Salem, NC
  • NPI 1124002423
  NPD
• Michael Brandon Berry, MD

  • Vascular & Interventional Radiology Physician
  • Greenville, NC
  • NPI 1881612000

  Diagnostic Radiology

  NPD
• Austin Matthew Bond, MD

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1467849208

  Diagnostic Radiology

  NPD
• Kelly Ann Brozzetti-Cronin, M.D.

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1093973273

  Diagnostic Radiology

  NPD
• Jacob Joseph Bundy, MD

  • Body Imaging Physician
  • Winston Salem, NC
  • NPI 1902396898
  NPD
• Karol Lissette Cardenas Montalvo, MD

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1699400580

  Diagnostic Radiology

  NPD

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1700490232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRESCENT CENTRE DR STE 400",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677270",
            "telephone_number": "615-261-2306",
            "fax_number": "855-588-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 OLD WINSTON RD STE 105",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847141",
            "telephone_number": "336-765-5722",
            "fax_number": "336-765-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST BAPTIST IMAGING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST BAPTIST IMAGING, LLC",
        "enumeration_date": "2020-09-02",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "615-261-2306"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atrium Health Wake Forest Baptist Imaging - Kernersville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brennan Ehlinger Visser, PT, DPT, ATC
• Vitality Wellness Counseling & Clinical Services PLLC
• Mai Lee Vue, LCSW
• Eugene Henry Peter Wade, MD
• Lori Jean Wainright, MS, LPC
• Wake Forest Health Network LLC
• Wake Forest Health Network LLC
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wal-Mart Stores East LP

• All providers in Kernersville, NC
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.