Wilkes Dialysis Center of Wake Forest University

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

WILKES DIALYSIS CENTER OF WAKE FOREST UNIVERSITY

Practice address

1917 W Park Dr # a
North Wilkesboro, NC 28659-3564

Phone

(336) 667-3762

Fax

(336) 667-1183

NPI assigned

Jul 7, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly Agee-Clark Johnson, MBA

Title

Credentialing Coord.

Phone

(229) 387-3528

Specialties & licenses 1

Addresses

Other names 1

• Wilkes Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Wilkes Dialysis Center of Wake Forest UniversityCCN 342724

Overall star rating

3.0 of 5

Ownership

Non-profit

Certified

Feb 16, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

Wake Forest University

Dialysis stations

24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1134731227

  Member Of

  NPD member

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Isai G Bowline, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1225260391

  Dialysis facility

  Care Compare affiliation Name & address match
• Barry Ira Freedman, MD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1245215672

  Dialysis facility

  Care Compare affiliation Name & address match
• Taewoo Lee, MD, PHD

  • Nephrology Physician
  • Winston Salem, NC
  • NPI 1033649819

  Dialysis facility

  Care Compare affiliation Name & address match
• Wolfgang Erich Lohrmann, MD

  • Nephrology Physician
  • Statesville, NC
  • NPI 1225059017

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770595200000",
    "number": "1760904155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7350",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317937350",
            "telephone_number": "229-387-3528",
            "fax_number": "229-386-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1917 W PARK DR # A",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593564",
            "telephone_number": "336-667-3762",
            "fax_number": "336-667-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKES DIALYSIS CENTER OF WAKE FOREST UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-07",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "AGEE-CLARK",
        "authorized_official_title_or_position": "CREDENTIALING COORD.",
        "authorized_official_telephone_number": "229-387-3528",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilkes Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerald Mitchell Wiles Jr., PT
• Wilkes Adult Developmental Activity Program
• Wilkes Anesthesia Associates PA
• Wilkes County Schools
• Wilkes Dental Consortium
• Wilkes Pediatric Clinic, PLLC
• Wilkes Physician Network, Inc.
• Wilkes Physician Network, Inc.
• Wilkes Physician Network, Inc.
• Wilkes Physician Network, Inc.

• All providers in North Wilkesboro, NC
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; 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.