FORSYTH MEDICAL GROUP, LLC (NPI# 1912198672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912198672 |
| Entity Type | Organization |
| Organization Name | FORSYTH MEDICAL GROUP, LLC |
| Other Organization Name | WINSTON-SALEM HEALTHCARE (CAPITATION PLAN) |
| Practice Address |
250 Charlois Blvd Dba Winston-salem Healthcare (capitated Plan) Winston Salem NC 27103-1508 |
| Mailing Address |
2000 Frontis Plaza Blvd Ste 102 Novant Medical Group Winston Salem NC 27103-5616 |
| Practice Telephone | 3367181000 |
| Practice Fax Number | 3367181298 |
| Mailing Telephone | 3367181000 |
| Mailing Fax Number | 3367181298 |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2008-08-14 |
| Authorized Official Name | HEAVENNY BRADSHAW (ENROLLMENT COORDINATOR) |
| Authorized Official Telephone | 3366792661 |
| Is Organization Subpart | Y |
| Parent Organization Name | FORSYTH MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | RAILROAD MEDICARE | CJ2926 | 01 |
| NC | BCBS CAPITATION NUMBER | 015WW | 01 |
| NC | 590118P | 05 |
| Other Name | Type Code |
|---|---|
| Winston-Salem Healthcare (Capitation Plan) | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467876961 | Forsyth Medical Group, LLC | Pediatrics | 3431 Walkertown Commons Drive, Walkertown, NC 27051 | 2014-02-05 |
| 1740599778 | Forsyth Medical Group, LLC | Pediatrics | 1471 Jag Branch Blvd Ste 101, Kernersville, NC 27284-6956 | 2010-09-24 |
| 1508186834 | Forsyth Medical Group, LLC | Urology | 1219 Lexington Ave Ste D, Thomasville, NC 27360-2784 | 2010-06-09 |
| 1083850069 | Forsyth Medical Group, LLC | Internal Medicine | 208 W Center St Ste B, Lexington, NC 27292-3046 | 2008-12-23 |
| 1124171160 | Forsyth Medical Group, LLC | Pediatrics | 2205 Oak Ridge Rd Ste Bb, Dba Forsyth Pediatrics Oakridge, Oak Ridge, NC 27310-8738 | 2007-01-22 |
| 1245288786 | Forsyth Medical Group, LLC | Internal Medicine | 2000 Frontis Plaza Blvd Ste 102, Winston Salem, NC 27103-5616 | 2006-05-05 |
| 1447208541 | Forsyth Medical Group, LLC | Internal Medicine | 445 Pineview Dr Ste 220, Dba Winston-salem Cardiology, Kernersville, NC 27284-3662 | 2006-05-04 |
| 1841839388 | Forsyth Medical Group, LLC | Nurse Practitioner | 207 Old Lexington Rd, Thomasville, NC 27360-3428 | 2020-01-02 |
| 1205393600 | Forsyth Medical Group, LLC | Internal Medicine | 144 Forest Hill Rd Ste 144&146, Lexington, NC 27295-2008 | 2019-02-22 |
| 1710444112 | Forsyth Medical Group, LLC | Pediatrics | 167 Moore Rd, King, NC 27021-8770 | 2019-02-22 |
| Street Address |
250 CHARLOIS BLVD DBA WINSTON-SALEM HEALTHCARE (CAPITATED PLAN) |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-1508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972503449 | Ryan Angus Mcdonald | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2005-07-27 |
| 1790266310 | Ashleigh Wynne Lucas | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2018-08-22 |
| 1841651841 | Alexandra Gilmore Sheppard | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2016-03-18 |
| 1922409234 | Tacorya Denise Morrison | Pharmacist | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2014-09-06 |
| 1831508860 | Sarah D Pearce | Pharmacist | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2014-08-04 |
| 1497183206 | Forsyth Memorial Hospital Inc | Internal Medicine | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-10-15 |
| 1265868764 | Forsyth Memorial Hospital, Inc | Internal Medicine | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-09-17 |
| 1083055396 | Phillip A Kelley | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-07-15 |
| 1427493980 | Marian Virginia Hazy | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-05-09 |
| 1609120690 | Tangula Latrice Simmons | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2012-10-30 |
| 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 | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043876055 | Iora Health North Carolina, P.C. | Internal Medicine | 3274 Silas Creek Pkwy, Winston Salem, NC 27103-3010 | 2019-05-15 |
| 1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
| 1740636125 | Joshua W Harbaugh | Internal Medicine | Gme Office Wfbmc Medical Center Blvd, Winston Salem, NC 27157-0001 | 2016-05-04 |
| 1922495795 | Lauren Marie Hartman | Internal Medicine | Sticht Center, 1 Medical Center Blvd, Winston Salem, NC 27517 | 2015-04-20 |
| 1952798985 | Adam Ross Schertz | Internal Medicine | Wake Forest Medical Ctr, Medical Center Blvd, Watlington Hall, 3rd Floor, Winston Salem, NC 27157-0001 | 2015-04-16 |
| 1881002319 | Glorian Mari Roman-ashby | Internal Medicine | Geriatric Clinic-sticht Center Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2014-07-28 |
| 1457648412 | Jiaxi Ding | Internal Medicine | 1340 Creekshire Way Ste 100, Winston Salem, NC 27103-3063 | 2011-06-28 |
| 1730319583 | Jennifer L Gabbard | Internal Medicine | 1 Medical Center Blvd 8th Floor Janeway Tower, Winston Salem, NC 27157-0001 | 2009-07-14 |
| 1730349309 | Willis S Mozingo | Internal Medicine | Wfubmc House Staff Ofc, Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2008-06-16 |
| 1013104520 | Tong Li-masters | Internal Medicine | 830 Rockford Street, Winston Salem, NC 27030 | 2007-09-28 |
| 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.