Pine Haven Family Medicine PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9900682 Issued in NC

Legal business name

PINE HAVEN FAMILY MEDICINE PA

Practice address

604 West Academy St
Randleman, NC 27317

Phone

(336) 498-1200

Fax

(336) 498-1206

NPI assigned

Apr 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. John James Slatosky Jr., DONPI 1982676441

Title

Owner Physician

Phone

(336) 498-1200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John James Slatosky Jr., D.O.

  • Family Medicine Physician
  • Randleman, NC
  • NPI 1982676441

  Family Medicine, NC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354233600000",
    "number": "1891960241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 WEST ACADEMY ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "27317",
            "telephone_number": "336-498-1200",
            "fax_number": "336-498-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 WEST ACADEMY ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "27317",
            "telephone_number": "336-498-1200",
            "fax_number": "336-498-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE HAVEN FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2012-11-30",
        "status": "A",
        "authorized_official_last_name": "SLATOSKY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "336-498-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9900682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891212U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2348546",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip T Olshinski, F.N.P.
• Onsite Eyecare OD PA
• Amanda Beth Pearce, P.T.
• Tiffany Perrigo
• Javius Pettiford
• Kelly Jay Poole, LCSW
• Malvis Ramirez
• Randleman Drug LLC
• Randleman Medical Center
• Randleman Medical Center LLC

• All providers in Randleman, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.