Forsyth Memorial Hospital Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FORSYTH MEMORIAL HOSPITAL INC

Doing business as

Novant Health Premier Medical Associates

Practice address

3333 Brookview Hills Blvd
Suite 204
Winston Salem, NC 27103-5661

Phone

(336) 774-3740

Fax

(336) 774-3780

NPI assigned

Jan 23, 2006

Last updated

Jul 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leea Jeanine Walton

Title

Edi Manager

Phone

(704) 316-6081

Specialties & licenses 5

Addresses

Other identifiers 4

Other names 1

• Novant Health Premier Medical Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Stacey Jo Edwards, FNP-C

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1255923629
  NPD
• Robert Theodore Toborg, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1003813650
  NPD

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1851371066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-774-3740",
            "fax_number": "336-774-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BROOKVIEW HILLS BLVD",
            "address_2": "SUITE 204",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035661",
            "telephone_number": "336-774-3740",
            "fax_number": "336-774-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORSYTH MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "EDI MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP AETNA NUMBER",
            "identifier": "02570",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS NUMBER",
            "identifier": "015TK",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA89015TK",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP UHC NUMBER",
            "identifier": "2452425",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Premier Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Premier Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Forsyth Memorial Hospital Inc (Novant Health Forsyth Internal Medicine)
• Forsyth Memorial Hospital Inc (Novant Health Forsyth Endocrine Consultants)
• Forsyth Memorial Hospital Inc (Novant Health Forsyth Neurology)
• Forsyth Memorial Hospital Inc (Novant Health Cancer Genetics Counseling Clinic)
• Forsyth Memorial Hospital Inc (Novant Health Cancer Prevention and Wellness Clinic)
• Forsyth Memorial Hospital Inc (Novant Health Salem Family Medicine)
• Forsyth Memorial Hospital Inc (Novant Health Maplewood Family Medicine)
• Forsyth Memorial Hospital Inc (Novant Health Inpatient Stroke and Neurosciences)
• Forsyth Memorial Hospital, Inc (Novant Health Cancer Institute)
• Forsyth Memorial Hospital, Inc (Piedmont Medical Specialist)

• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.