NPIMap

Individual provider Active NPI

Jessica Brooke Koontz, MD

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1841721313
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2021-01793 Issued in NC
Practice address
1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101-3006
Phone
(336) 716-9253
NPI assigned
Mar 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 2021-01793 NC Primary

Addresses

Primary practice location

1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101-3006

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2011

Other practice location 1

13001 E 17th Pl
Aurora, CO 80045-2570
Phone (303) 724-6595

Other practice location 2

2295 E 14th St Ste 200
Winston Salem, NC 27105-6804
Phone (336) 716-3182

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
I20210915000631 NC Practitioner - Internal Medicine 1557638582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2021-01793NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Sep 1, 2021 Accepting new patients
North Carolina Baptist Hospital Past Accepting new patients

Locations

2295 E 14th St
Ste 200
Winston Salem, NC 27105

1200 N Martin Luther King Jr Dr
Winston Salem, NC 27101
Phone (336) 713-9800

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

Interoperability endpoints

  • Direct secure messaging: jkoontz2753963@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

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": "1490400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1841721313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2011",
            "fax_number": "336-713-9576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N MARTIN LUTHER KING JR DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013006",
            "telephone_number": "336-716-9253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13001 E 17th Pl",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452570",
            "country_code": "US",
            "telephone_number": "303-724-6595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2295 E 14th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271056804",
            "country_code": "US",
            "telephone_number": "336-716-3182",
            "fax_number": "336-713-9619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "JESSICA",
        "middle_name": "BROOKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-25",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2021-01793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.