Active NPI
Melissa Jane Knudson, M.D.
- Pediatrics Physician
- Winston Salem, NC
National Provider Identifier
1841649225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2024-01770
- Practice address
- Medical Center Blvd
Winston Salem, NC 27157-0001 - Phone
- (336) 716-9252
- Fax
- (336) 713-9387
- NPI assigned
- Jun 7, 2016
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 58194 | AZ | |
| Pediatrics Physician | 208000000X | MT210657 | PA | |
| Pediatrics Physician | 208000000X | 2024-01770 | NC | Primary |
Addresses
Primary practice location
Medical Center Blvd
Winston Salem, NC 27157-0001
Mailing address
100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 716-0238
Other practice location 1
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Phone (928) 729-8710
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: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT210657 | PA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Current | Accepting new patients |
Locations
Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697
100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947
Interoperability endpoints
- mknudson2926540@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.
-
- Multi-Specialty Clinic/Center
- Winston Salem, NC
- NPI 1003803032
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1841649225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KIMEL FOREST DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036074",
"telephone_number": "336-716-0238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-716-9252",
"fax_number": "336-713-9387"
}
],
"practiceLocations": [
{
"address_1": "Corner of Route N12 and N7",
"address_purpose": "LOCATION",
"city": "Fort Defiance",
"state": "AZ",
"postal_code": "86504",
"country_code": "US",
"telephone_number": "928-729-8710",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KNUDSON",
"first_name": "MELISSA",
"middle_name": "JANE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-07",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "58194",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MT210657",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "2024-01770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.