NPIMap

Organization Active NPI

Wake Forest University Baptist Medical Center Community Physicians

  • Pediatrics Physician
  • Winston Salem, NC
National Provider Identifier
1922091271
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Practice address
3746 Vest Mill Rd
Winston Salem, NC 27103-2912
Phone
(336) 774-0710
Fax
(336) 774-0707
NPI assigned
Aug 23, 2005
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Authorized official

Name
Mr. Lewis S Thorp III
Title
President Ceo
Phone
(336) 721-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X NC Primary

Addresses

Primary practice location

3746 Vest Mill Rd
Winston Salem, NC 27103-2912

Mailing address

3746 Vest Mill Rd
Winston Salem, NC 27103-2912
Phone (336) 774-0710

Other identifiers 1

IdentifierTypeStateIssuer
890290NMedicaidNC

Other names 1

  • Westgate Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peace Haven Urgent Care5 organizations share this tax ID, including this one
Part of
Peace Haven Urgent Care

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3746 Vest Mill Rd
Winston Salem, NC 27103
Phone (336) 713-0024

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1922091271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3746 VEST MILL RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032912",
            "telephone_number": "336-774-0710",
            "fax_number": "336-774-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3746 VEST MILL RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032912",
            "telephone_number": "336-774-0710",
            "fax_number": "336-774-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS",
        "enumeration_date": "2005-08-23",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "THORP",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "336-721-3900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890290N",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westgate Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.