NPIMap

Organization Active NPI

Spectrum Medical Group PA

  • Critical Care Medicine (Internal Medicine) Physician
  • Winston-Salem, NC
National Provider Identifier
1801878632
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
SPECTRUM MEDICAL GROUP PA
Practice address
3001 Lyndhurst Ave
Winston-Salem, NC 27103-4007
Phone
(336) 765-0383
Fax
(336) 760-6918
NPI assigned
Nov 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Authorized official

Name
Tammy Ferrell
Title
Administrator
Phone
(336) 765-0383

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X Primary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X

Addresses

Primary practice location

3001 Lyndhurst Ave
Winston-Salem, NC 27103-4007

Mailing address

3001 Lyndhurst Ave
Winston-Salem, NC 27103-4007
Phone (336) 765-0383

Other identifiers 2

IdentifierTypeStateIssuer
02258OtherNCBCBS
8902258MedicaidNC

Other names 1

  • Salem Chest Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000275 NC Part B Supplier - Clinic/Group Practice 1254234388 Receives reassigned benefits from 37 practitioners
Practice locations: Winston Salem, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0237600Spectrum Medical Group, PA3001 Lyndhurst Avenue, Winston-Salem, NC 27103Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1801878632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "FERRELL",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-765-0383"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02258",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902258",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salem Chest Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Salem Chest Specialists",
            "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 Apr 11, 2023; 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.