Individual provider Active NPI

Neil Teague Mashburn, PA

  • Medical Physician Assistant
  • Kernersville, NC
National Provider Identifier
1831155431
Registry record updated Jul 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
101146 Issued in NC
Practice address
420 W Mountain St
Kernersville, NC 27284-2534
Phone
(336) 993-1618
Fax
(336) 993-5340
NPI assigned
Apr 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 101146 NC Primary

Addresses

Primary practice location

420 W Mountain St
Kernersville, NC 27284-2534

Mailing address

2013 Middleham Dr
Kernersville, NC 27284-8650
Phone (336) 993-2460

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090123000548 NC Practitioner - Physician Assistant 2163586850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

601 N Elm St
High Point, NC 27262-4331
Phone (336) 716-2734

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • High Point Regional Health System Hospital, High Point, NC, CCN 340004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
101146NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Aug 15, 2016 Accepting new patients

Locations

910 Worth St
Mount Airy, NC 27030
Phone (336) 786-5108

791 Jonestown Rd
Winston Salem, NC 27103

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: nmashburn2755539@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1831155431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2013 MIDDLEHAM DR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272848650",
            "telephone_number": "336-993-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W MOUNTAIN ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842534",
            "telephone_number": "336-993-1618",
            "fax_number": "336-993-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASHBURN",
        "first_name": "NEIL",
        "middle_name": "TEAGUE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.