NPIMap

Organization Active NPI

Yadkin River Radiology PA

  • Diagnostic Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1710908041
Registry record updated Jun 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
YADKIN RIVER RADIOLOGY PA
Practice address
1365 Westgate Center Dr
Suite K-1
Winston Salem, NC 27103-2980
Phone
(336) 760-4450
Fax
(336) 760-6197
NPI assigned
Jul 22, 2006
Last updated
Jun 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2009

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

Authorized official

Name
Paul J Beerman, M.D.NPI 1548283831
Title
President
Phone
(336) 760-4450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

1365 Westgate Center Dr
Suite K-1
Winston Salem, NC 27103-2980

Mailing address

1365 Westgate Center Dr
Suite K-1
Winston Salem, NC 27103-2980
Phone (336) 760-4450

Other identifiers 1

IdentifierTypeStateIssuer
89015R1MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040603001082 NC Part B Supplier - Clinic/Group Practice 2860474715 Receives reassigned benefits from 4 practitioners
Practice locations: Elkin, NC; Sparta, NC
O20240223001083 FL Part B Supplier - Clinic/Group Practice 2860474715 Receives reassigned benefits from 1 practitioner
Practice locations: Pensacola, FL

National Provider Directory

National Provider Directory

Locations

1188 Yadkinville Rd
Mocksville, NC 27028
Phone (336) 716-7435

1365 Westgate Center Dr
Ste K1
Winston Salem, NC 27103
Phone (336) 760-4450

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245974400000",
    "number": "1710908041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 WESTGATE CENTER DR",
            "address_2": "SUITE K-1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032980",
            "telephone_number": "336-760-4450",
            "fax_number": "336-760-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 WESTGATE CENTER DR",
            "address_2": "SUITE K-1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032980",
            "telephone_number": "336-760-4450",
            "fax_number": "336-760-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YADKIN RIVER RADIOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2009-06-26",
        "status": "A",
        "authorized_official_last_name": "BEERMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-760-4450",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015R1",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; 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.