Individual provider Active NPI

Malcolm Truman Stark Jr., M.D.

  • Gastroenterology Physician
  • Greensboro, NC
National Provider Identifier
1891745261
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35521 Issued in NC
Practice address
520 N Elam Ave
Greensboro, NC 27403-1127
Phone
(336) 547-1700
NPI assigned
May 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35521 NC
Gastroenterology Physician 207RG0100X 35521 NC Primary

Addresses

Primary practice location

520 N Elam Ave
Greensboro, NC 27403-1127

Mailing address

1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 832-7000

Other identifiers 5

IdentifierTypeStateIssuer
4238777OtherNCAETNA
8979130MedicaidNC
2109OtherNCPARTNERS MEDICARE
42358OtherNCMEDCOST
79365OtherNCBCBS NC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mstark3879@direct.conehealth.com Direct

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090804000372 NC Practitioner - GastroenterologyPractitioner - Internal Medicine 9335292606 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Cone Medical Services, Inc. CurrentSince Feb 1, 1999 Accepting new patients
Moses Cone Medical Services, Inc. Internal Medicine CurrentSince Feb 1, 1999 Accepting new patients

Locations

300 E Wendover Ave
Fl 4
Greensboro, NC 27401
Phone (336) 663-5038

1126 N Church St
Ste 300
Greensboro, NC 27401
Phone (336) 547-1700

520 N Elam Ave
Greensboro, NC 27403
Phone (336) 475-7148

301 E Wendover Ave
Ste 411
Greensboro, NC 27401
Phone (336) 832-3200

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

940 Golf House Ct E
Whitsett, NC 27377
Phone (336) 449-9848

Interoperability endpoints

  • Direct secure messaging: mstark3879@direct.conehealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1891745261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N ELM ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011004",
            "telephone_number": "336-832-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N ELAM AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031127",
            "telephone_number": "336-547-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MALCOLM",
        "middle_name": "TRUMAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "35521",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "35521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4238777",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8979130",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE",
            "identifier": "2109",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "42358",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "79365",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mstark3879@direct.conehealth.com",
            "affiliation": "N",
            "endpointDescription": "Cone Health Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "520 N Elam Ave",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274031127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.