NPIMap

Individual provider Active NPI

Debra Clark, PA-C

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1720058282
Registry record updated Apr 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
103316 Issued in NC
Practice address
250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone
(336) 718-1000
Fax
(336) 718-1052
NPI assigned
Jan 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103316 NC Primary

Addresses

Primary practice location

250 Charlois Blvd
Winston Salem, NC 27103-1508

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001

Other identifiers 1

IdentifierTypeStateIssuer
8101696MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031126000407 NC Practitioner - Physician Assistant 8325942709 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • Atrium Health Wake Forest Baptist -Care at Home Home health agency, Winston Salem, NC, CCN 347106
  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
103316NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital Inc CurrentSince Apr 1, 2011 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2015 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Apr 1, 2011 Accepting new patients
Forsyth Memorial Hospital Inc Physician Assistant CurrentSince Apr 1, 2011 Accepting new patients
Piedmont Hematology-Oncology Associates, PLLC Past Accepting new patients

Locations

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

1010 Bethesda Ct
Winston Salem, NC 27103
Phone (336) 277-6000

1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101
Phone (336) 713-9800

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

175 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 718-1006

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

Interoperability endpoints

  • Direct secure messaging: dclark2755409@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460073600000",
    "number": "1720058282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "fax_number": "336-716-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CHARLOIS BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031508",
            "telephone_number": "336-718-1000",
            "fax_number": "336-718-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEBRA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2016-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101696",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.