NPIMap

Individual provider Active NPI

Omar Pastor Sangueza, MD

  • Dermatopathology (Pathology) Physician
  • Winston Salem, NC
National Provider Identifier
1770569436
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X
License
200000967 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2255
Fax
(336) 716-7595
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X 200000967 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

PO Box 344
Winston Salem, NC 27102-0344
Phone (336) 716-2255

Other identifiers 4

IdentifierTypeStateIssuer
006607080MedicaidVA
89126MPMedicaidNC
006600531MedicaidVA
G40302MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040415001346 NC Practitioner - Pathology 5799770111 Reassigns benefits to 3 organizations
I20260508003076 TN Practitioner - Pathology 5799770111 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Skin Surgery Center PAGroup PAC ID 3173599479, 72 clinicians
Cutaneous Pathology, P.a.Group PAC ID 0446314918, 2 clinicians
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

1450 Professional Park Dr
Winston Salem, NC 27103-1300
Phone (336) 724-2434

1800 S Hawthorne Rd
Suite 200
Winston Salem, NC 27103-4014
Phone (336) 817-9768

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

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Medical Park Hospital Hospital, Winston-Salem, NC, CCN 340148
  • Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007
  • High Point Regional Health System Hospital, High Point, NC, CCN 340004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Cutaneous Pathology, P.a. Dermatopathology CurrentSince Nov 1, 2008 Accepting new patients
Skin Surgery Center PA Dermatology CurrentSince Sep 1, 2017 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2002 Accepting new patients
Skin Surgery Center PA CurrentSince Sep 1, 2017 Accepting new patients

Locations

1450 Professional Park Dr
Ste 15
Winston Salem, NC 27103

1450 Professional Park Dr
Winston Salem, NC 27103
Phone (336) 724-2434

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

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

1450 Professional Park Dr
Ste 150
Winston Salem, NC 27103
Phone (336) 724-2434

1800 S Hawthorne Rd
#200
Winston Salem, NC 27103
Phone (336) 760-1388

1800 S Hawthorne Rd
#100
Winston Salem, NC 27103
Phone (336) 760-1388

Interoperability endpoints

  • Direct secure messaging: osangueza2754025@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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 10

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1770569436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-7595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-7595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANGUEZA",
        "first_name": "OMAR",
        "middle_name": "PASTOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NC",
            "license": "200000967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006607080",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89126MP",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006600531",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G40302",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.