Dittana Phoncharoensri, M.D.

Primary specialty

Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X

License

201300784 Issued in NC

Practice address

152 E Kinderton Way Ste 101
Bermuda Run, NC 27006-7351

Phone

(336) 893-3180

Fax

(336) 893-3189

NPI assigned

Jun 11, 2007

Last updated

Oct 25, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Neurology

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148
• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dphoncharoensri198848@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Village Family Care

  • Family Medicine Physician
  • Wake Forest, NC
  • NPI 1659571768
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Oceanside Family Medicine

  • Family Medicine Physician
  • Leland, NC
  • NPI 1255724571
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Neurology and Sleep

  • Neurology Physician
  • Salisbury, NC
  • NPI 1447496120

  Sleep Medicine

  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)
• Clarksdale Hma Physician Management LLC

  • Internal Medicine Physician
  • Clarksdale, MS
  • NPI 1740297688
  NPD (past)

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

• Forsyth Memorial Hospital, Inc.

  dba Novant Health Forsyth Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation
• Medical Park Hospital LLC

  dba Novant Health Medical Park Hospital

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1538111828
  Care Compare affiliation

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1750585170",
    "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",
            "telephone_number": "336-893-3180",
            "fax_number": "336-893-3189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 E KINDERTON WAY STE 101",
            "city": "BERMUDA RUN",
            "state": "NC",
            "postal_code": "270067351",
            "telephone_number": "336-893-3180",
            "fax_number": "336-893-3189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 N Elm St",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272624332",
            "country_code": "US",
            "telephone_number": "336-889-8877",
            "fax_number": "336-889-5250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "606 N Elm St",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272624332",
            "country_code": "US",
            "telephone_number": "336-889-8877",
            "fax_number": "336-889-5250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHONCHAROENSRI",
        "first_name": "DITTANA",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "NC",
            "license": "201300784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750585170",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dphoncharoensri198848@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "606 N Elm St",
            "city": "High Point",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272624332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Novant Medical Group, Inc. (Novant Health Sleep Center)
• April Michelle Papineau, NP
• David Wesley Parker II, M.D., D.D.S.
• Michelle Dilipkumar Patel, M.D.
• Nathanael Elvin Phillips, MD
• Terrence Pittman
• David Carl Pollock, M.D.
• Davidson McKinley Pollock, PT, DPT
• Shruthi Ponnala, MD
• Sneha Raghavendra Rao, MD

• Sleep Medicine (Psychiatry & Neurology) Physician in Bermuda Run, NC
• Providers in Bermuda Run, NC by specialty
• Sleep Medicine (Psychiatry & Neurology) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.