NPIMap

Organization Active NPI

Wake Forest Baptist Imaging LLC

Doing business as Atrium Health Wake Forest Baptist Imaging Friendly - Mobile

  • Diagnostic Radiology Physician
  • Greensboro, NC
National Provider Identifier
1841049913
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
WAKE FOREST BAPTIST IMAGING LLC
Doing business as
Atrium Health Wake Forest Baptist Imaging Friendly - Mobile
Practice address
3120 Northline Ave Ste 3120-101
Greensboro, NC 27408-7814
Phone
(336) 765-5722
Fax
(336) 765-5723
NPI assigned
May 13, 2024
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Authorized official

Name
Amy Stout
Title
President/Ceo
Phone
(615) 261-2306

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary
Physiological Laboratory 293D00000X

Addresses

Primary practice location

3120 Northline Ave Ste 3120-101
Greensboro, NC 27408-7814

Mailing address

PO Box 1000 Dept 842
Memphis, TN 38148-0842
Phone (615) 261-2306

Other names 1

  • Atrium Health Wake Forest Baptist Imaging Friendly - Mobile Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250116000041 NC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3173681681 Receives reassigned benefits from 1 practitioner
Practice locations: Greensboro, NC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Wake Forest Imaging LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3120 Northline Ave
Ste 3120101
Greensboro, NC 27408
Phone (336) 713-0818

Practitioners & affiliated clinicians

Practitioners 90

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1841049913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000 DEPT 842",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480842",
            "telephone_number": "615-261-2306",
            "fax_number": "855-588-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 NORTHLINE AVE STE 3120-101",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087814",
            "telephone_number": "336-765-5722",
            "fax_number": "336-765-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST BAPTIST IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "615-261-2306"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atrium Health Wake Forest Baptist Imaging Friendly - Mobile",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atrium Health Wake Forest Baptist Imaging Friendly - Mobile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.