Mark Jung Stallworth, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

9401055 Issued in NC

Practice address

1900 S Hawthorne Rd
Winston Salem, NC 27103-3913

Phone

(336) 970-5300

Fax

(336) 659-2379

NPI assigned

May 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Triad Radiology Associates PLLC

  • Diagnostic Radiology Physician
  • Winston Salem, NC
  • NPI 1659485001
  Medicare reassignment NPD
• Piedmont Imaging LLC

  • Diagnostic Radiology Physician
  • Winston-Salem, NC
  • NPI 1073571352
  NPD
• Foundation Health Systems Corp.

  • Gynecology Physician
  • Winston Salem, NC
  • NPI 1053379941
  NPD (past)
• Triad Radiology Associates, PLLC

  • Vascular & Interventional Radiology Physician
  • Winston Salem, NC
  • NPI 1447368659
  NPD (past)

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1912958794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 TRENWEST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033208",
            "telephone_number": "336-970-5300",
            "fax_number": "336-970-5298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033913",
            "telephone_number": "336-970-5300",
            "fax_number": "336-659-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "MARK",
        "middle_name": "JUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "9401055",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NC",
            "license": "9401055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8979159",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karyn Stagg, CRNA
• Lura W Stagg, M.D.
• Avril L Staley, BA, QP, CSAC-INTERN
• Meredith Staley, MSW, LCSW
• Ashley Moody Stallings, PHARMD
• Michael Shane Stalvey, MD
• Ashleigh Walker Stambaugh, RBT
• David M Stamilio, MD
• Daniel Beau Stamos, MD
• Tara H Stamper, MS

• Diagnostic Radiology Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Diagnostic Radiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.