NPIMap

Individual provider Active NPI

Trina Blair Dale

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1871128512
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-10718 Issued in NC
Practice address
175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951
Phone
(336) 718-3550
Fax
(336) 277-1825
NPI assigned
Mar 3, 2020
Last updated
Jun 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-10718 NC Primary

Addresses

Primary practice location

175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-3550

Other practice location 1

844 Highland Ave SE
Hickory, NC 28602-1111
Phone (828) 328-1741

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tdale839992@direct.novanthealth.org

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
I20201130002158 NC Practitioner - Physician Assistant 5991116774 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-5105

231 S 17TH St
Wilmington, NE 28401-7407
Phone (910) 667-5105

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-5000

3515 Whitehall Park Dr
Suite 300
Charlotte, NC 28273-4179

3545 Whitehall Park Dr
Suite 300
Charlotte, NC 28273-4179
Phone (980) 302-8850

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

800 Jefferson St
Suite 112
Whiteville, NC 28472-3702
Phone (910) 662-9500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-10718NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group, Inc. CurrentSince Nov 14, 2020 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 14, 2020 Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Nov 14, 2020 Accepting new patients
NMG Health Services LLC CurrentSince Jul 26, 2025 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Jul 26, 2025 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Nov 14, 2020 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

13815 Professional Center Dr
Ste 100
Huntersville, NC 28078
Phone (704) 316-2050

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1871128512",
    "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": "336-718-3550",
            "fax_number": "336-277-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 KIMEL PARK DR STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036951",
            "telephone_number": "336-718-3550",
            "fax_number": "336-277-1825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "844 Highland Ave SE",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286021111",
            "country_code": "US",
            "telephone_number": "828-328-1741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALE",
        "first_name": "TRINA",
        "middle_name": "BLAIR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdale839992@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "175 Kimel Park Dr Ste 100",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.