NPIMap

Individual provider Active NPI

Timothy John Dalton, MD

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1912900648
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
95-00876 Issued in NC
Practice address
1995 Bethabara Rd
Winston-Salem, NC 27106-3375
Phone
(336) 759-7596
Fax
(336) 759-3652
NPI assigned
May 27, 2005
Last updated
Oct 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9500876 NC
Internal Medicine Physician 207R00000X 95-00876 NC Primary
Pediatrics Physician 208000000X 95-00876 NC

Addresses

Primary practice location

1995 Bethabara Rd
Winston-Salem, NC 27106-3375

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 759-7596

Other identifiers 10

IdentifierTypeStateIssuer
58523OtherMEDCOST
26793OtherBCBS
0402121OtherUNITED HEALTHCARE
5592041OtherAETNA PPO POS
287316OtherMAMSI
110113235OtherRAILROAD MEDICARE
10526OtherPARTNERS
410250659OtherCHAMPUS
2624358OtherAETNA HMO OPOS
8926793MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address TDALTON16354@DIRECT.NOVANTHEALTH.ORG

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
I20041018000909 NC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 7618937293 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
East Tennessee State University Quillen College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1995 Bethabara Rd
Winston Salem, NC 27106-3375
Phone (336) 759-7596

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95-00876NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. Family Medicine Current Accepting new patients
Forsyth Memorial Hospital Inc Family Medicine CurrentSince Apr 1, 2007 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2016 Accepting new patients
Novant Health Medical Group, LLC Family Medicine CurrentSince Nov 1, 2016 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Apr 1, 2007 Accepting new patients
Forsyth Memorial Hospital, Inc Family Medicine Past Accepting new patients
Mdco PA Family Medicine PastSince Aug 31, 2006 Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

105 Stadium Oaks Dr
Clemmons, NC 27012
Phone (336) 766-0547

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

280 Broad St
Ste B
Kernersville, NC 27284
Phone (336) 993-2224

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

290 W Wall St
Rural Hall, NC 27045
Phone (336) 969-1185

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

1995 Bethabara Rd
Winston Salem, NC 27106
Phone (336) 759-7596

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1912900648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-759-7596",
            "fax_number": "336-759-3652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 BETHABARA RD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271063375",
            "telephone_number": "336-759-7596",
            "fax_number": "336-759-3652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALTON",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9500876",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "95-00876",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "95-00876",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "58523",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "26793",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0402121",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO POS",
            "identifier": "5592041",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "287316",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110113235",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "10526",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "410250659",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO OPOS",
            "identifier": "2624358",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8926793",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TDALTON16354@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "1995 Bethabara Rd",
            "city": "Winston-Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271063375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.