Sallie Lynn Staley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-00117 Issued in NC

Practice address

1908 Caudle Dr Ste 200
Mount Airy, NC 27030-4322

Phone

(336) 783-6935

Fax

(336) 783-6934

NPI assigned

Jan 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
• Northern Regional Hospital Hospital, Mount Airy, NC, CCN 340003

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Forsyth Memorial Hospital, Inc.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment Care Compare group
• Novant Health Rowan Medical Center LLC

  • Neurology Physician
  • Salisbury, NC
  • NPI 1508931544
  Medicare reassignment
• Novant Health Thomasville Medical Center, LLC

  • Specialist
  • Thomasville, NC
  • NPI 1033160205
  Medicare reassignment
• Forsyth Memorial Hospital Inc

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1548584162
  NPD
• Novant Health Thomasville Medical Center LLC

  • Hematology & Oncology Physician
  • Winston Salem, NC
  • NPI 1649159609
  NPD
• Novant Health Thomasville Medical Center, LLC

  • Hematology & Oncology Physician
  • Winston Salem, NC
  • NPI 1487309860
  NPD
• Rowan Regional Medical Center

  • Cardiovascular Disease Physician
  • Salisbury, NC
  • NPI 1679812010
  NPD
• Forsyth Memorial Hospital, Inc

  • Family Medicine Physician
  • Mount Airy, NC
  • NPI 1295783108
  NPD (past)
• Piedmont Hematology-Oncology Associates, PLLC

  • Hematology & Oncology Physician
  • Winston Salem, NC
  • NPI 1245210707

  Medical

  NPD (past)

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

• Forsyth Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation
• Northern Hospital of Surry County

  • General Acute Care Hospital
  • Mount Airy, NC
  • NPI 1366449282
  Care Compare affiliation

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1821068768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 CAUDLE DR STE 200",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270304322",
            "telephone_number": "336-783-6935",
            "fax_number": "336-783-6934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1913 W Park Dr",
            "address_purpose": "LOCATION",
            "city": "North Wilkesboro",
            "state": "NC",
            "postal_code": "286593564",
            "country_code": "US",
            "telephone_number": "336-903-6362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271573564",
            "country_code": "US",
            "telephone_number": "336-713-5440",
            "fax_number": "336-713-5445",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 Bethesda Ct",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271033019",
            "country_code": "US",
            "telephone_number": "336-277-8800",
            "fax_number": "336-277-8850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALEY",
        "first_name": "SALLIE",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "001000117",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8101699",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sstaley154684@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1913 W Park Dr",
            "city": "North Wilkesboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286593564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Southern Living Home Care Services
• Hannah Spangler
• Terry Christopher Speaks
• Kathryn Morrison Spencer-Moore
• Kimberly Gillispie Spencer, LPC
• Roger Dale Stamper
• Katie Lynn Starling, PA-C
• John Michael Stevens, PT, DPT
• Leslie Marie Stoklosa, DC
• Brittany Knicely Street, NP

• Physician Assistant in Mount Airy, NC
• Providers in Mount Airy, 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 Sep 22, 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.