NPIMap

Organization Active NPI

Wake Forest University Baptist Medical Center Community Physicians

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1942489695
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
Practice address
2801 Lyndhurst Ave
Winston Salem, NC 27103-4109
Phone
(336) 768-9575
Fax
(336) 774-1737
NPI assigned
Oct 30, 2007
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
Lewis S Thorp III
Title
President/Ceo
Phone
(336) 721-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2801 Lyndhurst Ave
Winston Salem, NC 27103-4109

Mailing address

2801 Lyndhurst Ave
Winston Salem, NC 27103-4109
Phone (336) 768-9575

Other identifiers 2

IdentifierTypeStateIssuer
5908389MedicaidNC
2317728XOtherNCMEDICARE GROUP NUMBER

Other names 1

  • Club Haven Family Practice Doing business as

National Provider Directory

National Provider Directory
Part of
Peace Haven Urgent Care

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.

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1942489695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034109",
            "telephone_number": "336-768-9575",
            "fax_number": "336-774-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034109",
            "telephone_number": "336-768-9575",
            "fax_number": "336-774-1737"
        }
    ],
    "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": "2007-10-30",
        "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_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908389",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2317728X",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Club Haven Family Practice",
            "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.