NPIMap

Individual provider Active NPI

Courtney Forcucci Ollis, PA-C

  • Physician Assistant
  • Greensboro, NC
National Provider Identifier
1831585801
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05668 Issued in NC
Practice address
3903 N Elm St
Greensboro, NC 27455-2877
Phone
(336) 716-2255
NPI assigned
Apr 7, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0010-05668 NC
Physician Assistant 363A00000X 0010-05668 NC Primary

Addresses

Primary practice location

3903 N Elm St
Greensboro, NC 27455-2877

Mailing address

5928 W Friendly Ave
Greensboro, NC 27410-3265
Phone (803) 493-5630

Other practice location 1

1511 Westover Ter
Suite 103
Greensboro, NC 27408-7128
Phone (336) 378-9906

Other practice location 2

500 Shepherd St
Winston Salem, NC 27103-1633
Phone (336) 716-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150626000815 NC Practitioner - Physician Assistant 8527370923 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

3903 N Elm St
Greensboro, NC 27455-2594
Phone (336) 713-4944

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

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-05668NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Physicians and Associates PA CurrentSince Apr 17, 2018 Accepting new patients
Eagle Physicians and Associates PA CurrentSince Apr 17, 2018 Accepting new patients
Wake Forest University Health Sciences CurrentSince May 11, 2015 Accepting new patients
North Carolina Baptist Hospital Past Accepting new patients
Greensboro Adult and Adolescent Internal Medicine PA Internal Medicine PastSince Jun 1, 1996 Accepting new patients

Locations

3903 N Elm St
Greensboro, NC 27455
Phone (336) 716-4131

1814 Westchester Dr
Ste 203C
High Point, NC 27262

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

500 Shepherd St
Winston Salem, NC 27103
Phone (336) 716-3325

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

Interoperability endpoints

  • Direct secure messaging: collis2755343@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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 5

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": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1831585801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5928 W FRIENDLY AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274103265",
            "telephone_number": "803-493-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 N ELM ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274552877",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1511 Westover Ter",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274087128",
            "country_code": "US",
            "telephone_number": "336-378-9906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Shepherd St",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031633",
            "country_code": "US",
            "telephone_number": "336-716-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLLIS",
        "first_name": "COURTNEY",
        "middle_name": "FORCUCCI",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "0010-05668",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.