Individual provider Active NPI

Bill Allen Ricketts, PA

  • Physician Assistant
  • Kernersville, NC
National Provider Identifier
1730149824
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102017 Issued in NC
Practice address
240 Broad St
Kernersville, NC 27284-2930
Phone
(336) 993-8333
NPI assigned
Mar 24, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 102017 NC Primary

Addresses

Primary practice location

240 Broad St
Kernersville, NC 27284-2930

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bricketts16666@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230710000590 NC Practitioner - Physician Assistant 2062652712 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince May 28, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 28, 2023 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

1471 Jag Branch Blvd
Unit 101
Kernersville, NC 27284
Phone (336) 515-7420

4901 Auburn Rd
Summerfield, NC 27358
Phone (336) 660-5270

2000 Frontis Plaza Blvd
Ste 200
Winston Salem, NC 27103
Phone (336) 277-2435

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1730149824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 BROAD ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842930",
            "telephone_number": "336-993-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "BILL",
        "middle_name": "ALLEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2023-03-07",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bricketts16666@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "240 Broad St",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.