Cedar Creek Family Medicine PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

88463 Issued in NC

Legal business name

CEDAR CREEK FAMILY MEDICINE PLLC

Practice address

11492 Old US Highway 52
Winston Salem, NC 27107-9497

Phone

(336) 784-0505

Fax

(336) 784-0531

NPI assigned

Feb 13, 2008

Last updated

Sep 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly R Nifong, MD

Title

Co Owner

Phone

(336) 784-0505

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11229/brand/1/csg/1/fhir/r4

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nancy Alexis Nifong, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1043586605
  Medicare reassignment Care Compare group
• Ted James Nifong, MD

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1063599587
  Medicare reassignment Care Compare group
• Katherine Henriques, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1306353784

  Single Specialty

  Medicare reassignment NPD
• Julie Beth Bain, PA

  • Physician Assistant
  • Oak Ridge, NC
  • NPI 1831279561
  Medicare reassignment
• Kimberly Renee Ragsdale, MD

  • Family Medicine Physician
  • Lexington, NC
  • NPI 1326125840
  Medicare reassignment
• Charity A. Martin, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1497731434
  NPD

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1952579807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 S MAIN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079174",
            "telephone_number": "336-784-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11492 OLD US HIGHWAY 52",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079497",
            "telephone_number": "336-784-0505",
            "fax_number": "336-784-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "NIFONG",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "336-784-0505",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "88463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "014U9",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014U9",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bobbi Ruel Cave, LAT, ATC
• Victoria Caviness
• Josefina Cazares, LCSWA
• James Parker Cecil, PT, DPT
• William Tyler Cecil, D.O.
• Natalie Torres Cedillo, OTR/L
• Ceg Care Home Care
• Ceg Care Home Care (Ceg Care Transportation)
• Frank Samuel Celestino, MD
• Cemor Services

• Primary Care Clinic/Center in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.