NPIMap

Individual provider Active NPI

Suresh Jillellamudi, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Winston Salem, NC
National Provider Identifier
1982869574
Registry record updated Mar 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
2020-04806 Issued in NC
Practice address
3001 Lyndhurst Ave
Winston Salem, NC 27103-4007
Phone
(336) 765-0383
Fax
(336) 760-6918
NPI assigned
Jul 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2020-04806 NC
Infectious Disease Physician 207RI0200X 2020-04806 NC
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 2020-04806 NC Primary

Addresses

Primary practice location

3001 Lyndhurst Ave
Winston Salem, NC 27103-4007

Mailing address

3001 Lyndhurst Ave
Winston Salem, NC 27103-4007
Phone (336) 765-0383

Other identifiers 1

IdentifierTypeStateIssuer
2080858MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sjillellamudi883127@direct.novanthealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210902002249 NC Practitioner - Critical Care (Intensivists)Practitioner - Infectious Disease 3779757349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Infectious Disease
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Spectrum Medical Group PA 15 clinicians
Novant Health Medical Group, LLC 2,413 clinicians

Practice addresses (Care Compare)

3001 Lyndhurst Ave
Winston Salem, NC 27103-4007
Phone (336) 765-0383

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-7597

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Northern Regional Hospital Hospital, Mount Airy, NC, CCN 340003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Critical Care Medicine CurrentSince Dec 15, 2021 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 15, 2021 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Spectrum Medical Group PA Critical Care Medicine CurrentSince Aug 30, 2021 Accepting new patients

Locations

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

3001 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 765-0383

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

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

Interoperability endpoints

  • Direct secure messaging: sjillellamudi883127@direct.novanthealth.org

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 2

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": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1982869574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 LYNDHURST AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-0383",
            "fax_number": "336-760-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JILLELLAMUDI",
        "first_name": "SURESH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-23",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2020-04806",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NC",
            "license": "2020-04806",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "2020-04806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2080858",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjillellamudi883127@direct.novanthealth.org",
            "affiliation": "N",
            "endpointDescription": "direct",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3001 Lyndhurst Ave",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271034007",
            "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.