NPIMap

Organization Active NPI

Keystone WSNC LLC

Doing business as Old Vineyard Physician Group

  • Psychiatry Physician
  • Winston Salem, NC
National Provider Identifier
1780817452
Registry record updated Sep 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MHH0188 Issued in NC
Legal business name
KEYSTONE WSNC LLC
Doing business as
Old Vineyard Physician Group
Practice address
3637 Old Vineyard Rd
Winston Salem, NC 27104
Phone
(336) 794-3550
Fax
(336) 794-4339
NPI assigned
Aug 28, 2009
Last updated
Sep 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2018

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

Authorized official

Name
Mr. Steve Filton
Title
Vice President
Phone
(610) 768-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MHH0188 NC Primary

Addresses

Primary practice location

3637 Old Vineyard Rd
Winston Salem, NC 27104

Mailing address

3637 Old Vineyard Rd
Winston Salem, NC 27104-4842
Phone (336) 794-3550

Other names 1

  • Old Vineyard Physician Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091030000579 NC Part B Supplier - Clinic/Group Practice 2567466386 Receives reassigned benefits from 7 practitioners
Practice locations: Winston Salem, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Keystone WSNC LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3637 Old Vineyard Rd
Winston Salem, NC 27104
Phone (336) 794-3550

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536019200000",
    "number": "1780817452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 OLD VINEYARD RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044842",
            "telephone_number": "336-794-3550",
            "fax_number": "336-794-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3637 OLD VINEYARD RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27104",
            "telephone_number": "336-794-3550",
            "fax_number": "336-794-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE WSNC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-28",
        "last_updated": "2018-09-04",
        "status": "A",
        "authorized_official_last_name": "FILTON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "610-768-3300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "MHH0188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Vineyard Physician Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Old Vineyard Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.