NPIMap

Organization Active NPI

Moses Cone Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Greensboro, NC
National Provider Identifier
1891008207
Registry record updated Feb 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOSES CONE AFFILIATED PHYSICIANS, INC.
Practice address
1200 North Elm Street
Moses Cone Health System-Administrative SVC, Ste. 201
Greensboro, NC 27401-1020
Phone
(336) 832-8005
Fax
(336) 832-8272
NPI assigned
Jul 15, 2010
Organization subpart
Yes
Parent organization
THE MOSES H. CONE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 14, 2011

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

Authorized official

Name
Mr. Kenneth K Boggs
Title
Cfo/Treasurer
Phone
(336) 832-8005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X NC Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X NC

Addresses

Primary practice location

1200 North Elm Street
Moses Cone Health System-Administrative SVC, Ste. 201
Greensboro, NC 27401-1020

Mailing address

1200 North Elm Street
Moses Cone Health System-Administrative SVC. Ste. 201
Greensboro, NC 27401-1020
Phone (336) 832-8005

Other identifiers 1

IdentifierTypeStateIssuer
5914946MedicaidNC

Other names 1

  • Preston S. Clark, MD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000512 NC Part B Supplier - Clinic/Group Practice 3779635396 Receives reassigned benefits from 86 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Reidsville, NC; Oak Ridge, NC; Kernersville, NC; High Point, NC; Burlington, NC; Asheboro, NC

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

National Provider Directory

National Provider Directory
Part of
Moses Cone Mem Hosp

NPI Registry JSON

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297641600000",
    "number": "1891008207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NORTH ELM STREET",
            "address_2": "MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC. STE. 201",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011020",
            "telephone_number": "336-832-8005",
            "fax_number": "336-832-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NORTH ELM STREET",
            "address_2": "MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC, STE. 201",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011020",
            "telephone_number": "336-832-8005",
            "fax_number": "336-832-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES CONE AFFILIATED PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MOSES H. CONE MEMORIAL HOSPITAL",
        "enumeration_date": "2010-07-15",
        "last_updated": "2011-02-14",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO/TREASURER",
        "authorized_official_telephone_number": "336-832-8005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914946",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preston S. Clark, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.