DR. KENNETH E BODEK (NPI# 1871587923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871587923 |
| Entity Type | Individual |
| Full Name | DR. KENNETH E BODEK |
| Credential | M.D. |
| Practice Address |
186 Kimel Park Dr Suite 400 Winston Salem NC 27103-6946 |
| Mailing Address |
Po Box 751803 Suite 400 Charlotte NC 28275-1803 |
| Practice Telephone | 3362772000 |
| Practice Fax Number | 3362772050 |
| Mailing Telephone | 3362772000 |
| Mailing Fax Number | 3362772050 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2020-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
2013-01642 | NC | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
MD046703L | PA | Allopathic & Osteopathic Physicians |
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
MD046703L | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | MEDICARE | 024733E15 | 01 |
| PA | 0012804190005 | 05 |
| Street Address |
186 KIMEL PARK DR SUITE 400 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-6946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851940753 | Casey Leigh Hardy | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2019-09-04 |
| 1881248029 | Ennie Austin | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2019-07-26 |
| 1972023737 | Francis Wingate Hayes Iv | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2017-06-22 |
| 1255786273 | Nathan Mcgeathy | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2016-04-27 |
| 1376925214 | Joseph Mintz | Physician Assistant | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2015-06-27 |
| 1679961353 | Michelle Swaim | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2015-01-02 |
| 1508107707 | Jennifer Doby Davis | Nurse Practitioner | 186 Kimel Park Dr, Winston Salem, NC 27103-6946 | 2013-03-13 |
| 1255682415 | Dawn Marie Delo O'reilly | Physician Assistant | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-09-27 |
| 1639431307 | Bradley Walton Clark | Internal Medicine | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-06-08 |
| 1285994426 | Pallavi Sharma Gomadam | Internal Medicine | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-05-22 |
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://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 |
|---|---|---|---|---|
| 1013194471 | Zahid A. Junagadhwalla | Internal Medicine | 2150 Country Club Rd, Winston Salem, NC 27104-4241 | 2008-01-29 |
| 1013127299 | Amer I Aladin | Internal Medicine | Medical Center Boulevard Department of Cardiology, Winston Salem, NC 27157-1045 | 2007-05-23 |
| 1366493751 | Barbara A Pisani | Internal Medicine | Medical Ctr, Winston Salem, NC 27157-0001 | 2006-05-12 |
| 1245288786 | Forsyth Medical Group, LLC | Internal Medicine | 2000 Frontis Plaza Blvd Ste 102, Winston Salem, NC 27103-5616 | 2006-05-05 |
| 1497739189 | Bt Heart and Vascular Center, Pllc | Internal Medicine | 150 Charlois Blvd, Suite 223, Winston Salem, NC 27103-1549 | 2005-12-06 |
| 1376195669 | Chloe Erin Decklever | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-07-16 |
| 1619529351 | Matthew Tyler Watson | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-07-12 |
| 1285298190 | Hannah Marie Mccallum | Internal Medicine | Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2019-04-25 |
| 1861913600 | Jade Mccormick Kiger | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-8708 | 2017-07-02 |
| 1568828903 | Regional Physicians LLC | Internal Medicine | 3333 Brookview Hills Blvd, Winston Salem, NC 27103 | 2016-01-14 |
| 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.