Individual provider Active NPI

Robert Dean Yakos, P.A.

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1932168473
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102658 Issued in NC
Practice address
4622 Country Club Rd Ste 180
Winston Salem, NC 27104-3770
Phone
(336) 768-9535
Fax
(336) 768-4155
NPI assigned
Mar 22, 2006
Last updated
Oct 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 84047 NC
Physician Assistant 363A00000X 102658 NC Primary
Surgical Physician Assistant 363AS0400X 84047 NC

Addresses

Primary practice location

4622 Country Club Rd Ste 180
Winston Salem, NC 27104-3770

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other identifiers 1

IdentifierTypeStateIssuer
84047OtherNCNC LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address byakos19914@direct.novanthealth.org
Direct Messaging Address BYAKOS19914@DIRECT.NOVANTHEALTH.ORG

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090928000785 NC Practitioner - Physician Assistant 2062568306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

2825 Lyndhurst Ave
Winston Salem, NC 27103-4146

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 277-1717

3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200

4622 Country Club Rd
Suite 180
Winston Salem, NC 27104-3770
Phone (336) 768-9535

5145 Sellers Rd
Shallotte, NC 28470-3405
Phone (910) 754-4572

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102658NCMDPhysician Assistant
84047NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group, Inc. CurrentSince Oct 1, 2009 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Oct 1, 2009 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

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

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

2915 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 760-0558

4622 Country Club Rd
Ste 180
Winston Salem, NC 27104
Phone (336) 768-9535

Interoperability endpoints

  • Direct secure messaging: byakos19914@direct.novanthealth.org

Organizations & group practices 4

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 1

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": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1932168473",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 COUNTRY CLUB RD STE 180",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043770",
            "telephone_number": "336-768-9535",
            "fax_number": "336-768-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAKOS",
        "first_name": "ROBERT",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2020-10-29",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "84047",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102658",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "84047",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "84047",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "byakos19914@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "2915 Lyndhurst Ave",
            "city": "Winston-Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271034005",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BYAKOS19914@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "4622 Country Club Rd Ste 180",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271043770",
            "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.