Active NPI
Traci D McMillian, MD
- Family Medicine Physician
- King, NC
National Provider Identifier
1821064189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9900940
- Practice address
- 216 Moore Rd
King, NC 27021-8703 - Phone
- (336) 983-4346
- NPI assigned
- Feb 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9900940 | NC | Primary |
Addresses
Primary practice location
216 Moore Rd
King, NC 27021-8703
Mailing address
2000 Frontis Plaza Blvd Ste 200
Attn Forsyth Medical Group
Winston Salem, NC 27103-5616
Phone (336) 277-2436
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891280G | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9900940 | NC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821064189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 FRONTIS PLAZA BLVD STE 200",
"address_2": "ATTN FORSYTH MEDICAL GROUP",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271035616",
"telephone_number": "336-277-2436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 MOORE RD",
"city": "KING",
"state": "NC",
"postal_code": "270218703",
"telephone_number": "336-983-4346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMILLIAN",
"first_name": "TRACI",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "9900940",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891280G",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in King, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.