Kenneth Edward Bodek, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

2013-01642 Issued in NC

Practice address

186 Kimel Park Dr
Suite 400
Winston Salem, NC 27103-6946

Phone

(336) 277-2000

Fax

(336) 277-2050

NPI assigned

Sep 6, 2005

Last updated

Nov 15, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Forsyth Memorial Hospital, Inc.

  dba NH Forsyth Primary Care Clinics

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1104548874
  Medicare reassignment Care Compare group NPD
• Novant Health Ballantyne Medical Center LLC

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
  • NPI 1760190607
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1306950282
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Mint Hill Medical Center, LLC

  dba Professional Fees

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
  • NPI 1063910404
  Medicare reassignment NPD
• The Presbyterian Hospital

  dba Novant Health Senior Care

  • Geriatric Medicine (Internal Medicine) Physician
  • Charlotte, NC
  • NPI 1053365817
  Medicare reassignment NPD
• Forsyth Memorial Hospital Inc

  dba Novant Health Triad Endocrine

  • Endocrinology, Diabetes & Metabolism Physician
  • Kernersville, NC
  • NPI 1417242439
  NPD
• Forsyth Memorial Hospital, Inc.

  dba FMC Professional Fees

  • Specialist
  • Winston Salem, NC
  • NPI 1154371052
  NPD
• Forsyth Memorial Hospital, Inc.

  dba Novant Health Heart & Vascular Institute - Frontis Plaza

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1932935475
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Cardiology Greensboro

  • Cardiovascular Disease Physician
  • Greensboro, NC
  • NPI 1568973360
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Heart and Vascular Institute

  • Cardiovascular Disease Physician
  • Charlotte, NC
  • NPI 1720590185
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Forsyth Memorial Hospital, Inc.

  dba Novant Health Forsyth Medical Center

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1447200233
  Care Compare affiliation

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1871587923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-277-2000",
            "fax_number": "336-277-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 KIMEL PARK DR",
            "address_2": "SUITE 400",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-277-2000",
            "fax_number": "336-277-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEK",
        "first_name": "KENNETH",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "2013-01642",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD046703L",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "PA",
            "license": "MD046703L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "024733E15",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012804190005",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbodek83510@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "186 Kimel Park Dr",
            "address_2": "Suite 400",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Elizabeth Board, LPC-A, LCAS-A
• Brendan James Boatman
• Rachel C Bobbitt
• Mackenzie Boccardo
• Allyson Bodamer, MS OTR/L
• Jason Kristopher Bodner, PA-C
• Brittany Nichole Bodwell, LCMHC
• George Michael Bodziock, M.D.
• Benjamin Joseph Boehnlein, CRNA
• Amy Boes, DPT

• Cardiovascular Disease Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Cardiovascular Disease Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.
• 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.