Kelley Erin Godbout, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10761 Issued in NC

Practice address

1 Medical Center Blvd
Winston Salem, NC 27157-4963

Phone

(336) 716-2011

NPI assigned

Jan 26, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iredell Physician Network LLCGroup PAC ID 0749345007, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgodbout2792831@carolinashealthcaresystem.direct-ci.com

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.

• Iredell Physician Network LLC

  • General Practice Physician
  • Statesville, NC
  • NPI 1811381593
  Medicare reassignment Care Compare group
• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment
• Iredell Physician Network LLC

  dba Iredell Ear, Nose and Throat

  • Otolaryngology Physician
  • Statesville, NC
  • NPI 1447063920
  NPD
• Iredell Physician Network, LLC

  dba Iredell Cardiology

  • Cardiovascular Disease Physician
  • Statesville, NC
  • NPI 1528633732
  NPD
• Iredell Physician Network LLC

  dba Bremnor Family Medicine

  • Family Medicine Physician
  • Mooresville, NC
  • NPI 1780822288
  NPD (past)

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

• Iredell Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Statesville, NC
  • NPI 1417944224
  Care Compare affiliation

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

{
    "created_epoch": "1579996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1801426127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5019 OLDE STONE LN",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281043354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271574963",
            "telephone_number": "336-716-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "844 Highland Ave SE",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286021111",
            "country_code": "US",
            "telephone_number": "828-328-7947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODBOUT",
        "first_name": "KELLEY",
        "middle_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-26",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keya Lachelle Glover, LCSW
• Aneta Barbara Glowacz, OTD, OTR/L
• Joseph M Gobern, M.D.
• Romel Hernandez Gobunsuy, M.D.
• Goco Surgical Associates PLLC
• Stephanie M. Goddard, NP
• Godel & Associates PLLC (Winston Salem Family Dental Care)
• Godel & Associates PLLC
• Natalie Godfrey, M.S., CCC-SLP
• Richard Kohlstadt Godine, PA-C

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.