DR. SAMUEL SPARROW PENDERGRAFT (NPI# 1013492180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013492180 |
| Entity Type | Individual |
| Full Name | DR. SAMUEL SPARROW PENDERGRAFT |
| Credential | PHD, PA-C |
| Practice Address |
140 Charlois Blvd Winston Salem NC 27103-1522 |
| Mailing Address |
506 Corona St Winston Salem NC 27103-2819 |
| Practice Telephone | 3367130319 |
| Mailing Telephone | 9197404990 |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-08261 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
140 CHARLOIS BLVD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-1522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477549707 | Robert James Evans IIi | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2005-09-22 |
| 1275031809 | Kristen Earwood | Physician Assistant | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2018-01-29 |
| 1043613730 | Megan Koonts Payne | Physician Assistant | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2014-10-08 |
| 1558762187 | Hooman Sadri-ardekani | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2014-09-15 |
| 1497172951 | Prabhakar Mithal | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2014-03-23 |
| 1215370606 | Kyle Scarberry | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2013-04-16 |
| 1518219864 | Jorge Gutierrez-aceves | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2012-10-11 |
| 1609133081 | Ram Anil Pathak | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2012-04-23 |
| 1184860421 | Majid Mirzazadeh | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2008-12-16 |
| 1295928539 | Ashok Kumar Hemal | Urology | 140 Charlois Blvd, Winston Salem, NC 27103-1522 | 2007-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598375032 | Anthony Gentile | Physician Assistant | 2632 Wynbrook Dr, Winston Salem, NC 27103-8005 | 2020-08-07 |
| 1376152074 | Meera Shah | Physician Assistant | 3288 Robinhood Rd Ste 202, Winston Salem, NC 27106-5464 | 2020-07-28 |
| 1770118457 | Heather Leigh Bissell | Physician Assistant | 153 Lavender Ln, Winston Salem, NC 27107-6023 | 2020-03-03 |
| 1245899806 | Cheryl L Sizer | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-06-07 |
| 1235606575 | Vincent James Alderete | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2018-10-25 |
| 1386127538 | Frederick Keith Stirewalt | Physician Assistant | Medical Center Blvd Faithhealth, Winston Salem, NC 27157-0001 | 2018-09-13 |
| 1164936852 | Lindsay Webster | Physician Assistant | 10479 Nc-109, 107a, Winston Salem, NC 27107 | 2017-11-17 |
| 1518477694 | Raul Canchari Ames | Physician Assistant | 512 Waughtown St, Winston Salem, NC 27127-2236 | 2017-10-03 |
| 1922528611 | Devon Adams | Physician Assistant | 1 Medical Center Blvd Gastroenterology Dept, Winston Salem, NC 27157-7223 | 2017-06-22 |
| 1053862474 | Seguin Warwick Beuerlein | Physician Assistant | 2425 Riley Forest Dr, Winston Salem, NC 27127-7573 | 2016-10-20 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.