NPIMap

Individual provider Active NPI

Iverson Brooks Carter, MD

  • Psychiatry Physician
  • Winston Salem, NC
National Provider Identifier
1891828224
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2005-01905 Issued in NC
Practice address
140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6185
Phone
(336) 718-7250
Fax
(336) 718-7260
NPI assigned
Mar 14, 2007
Last updated
Mar 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2005-01905 NC Primary

Addresses

Primary practice location

140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6185

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 718-7250

Other practice location 1

250 Charlois Blvd
Winston Salem, NC 27103-1508
Phone (336) 718-1004

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
I20090817000482 NC Practitioner - Psychiatry 4183778780 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Monarch CurrentSince Jun 25, 2020 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Jan 20, 2020 Accepting new patients
Daymark Recovery Services, Inc. Psychiatry CurrentSince Mar 25, 2012 Accepting new patients
Monarch CurrentSince Jun 25, 2020 Accepting new patients
Monarch Current Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 20, 2020 Accepting new patients
New River Service Authority Past Accepting new patients
New River Service Authority Past Accepting new patients

Locations

350 Pee Dee Ave
Ste 101
Albemarle, NC 28001
Phone (704) 986-1522

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

1104A S Main St
Lexington, NC 27292
Phone (336) 300-8836

820 Grimes Blvd
Lexington, NC 27292
Phone (336) 224-6071

2129 Statesville Blvd
Salisbury, NC 28147
Phone (704) 633-3616

175 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 718-1006

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

250 Charlois Blvd
Winston Salem, NC 27103
Phone (336) 718-1000

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1891828224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-718-7250",
            "fax_number": "336-718-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 KIMEL PARK DR STE 200",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036185",
            "telephone_number": "336-718-7250",
            "fax_number": "336-718-7260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031508",
            "country_code": "US",
            "telephone_number": "336-718-1004",
            "fax_number": "336-718-1061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARTER",
        "first_name": "IVERSON",
        "middle_name": "BROOKS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2005-01905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.