Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shane Cruz Prebis, PA

Individual provider Medical Physician Assistant · NPI 1053156521

Shane Cruz Prebis, PA is a Physician Assistant in Winston Salem, North Carolina. Qualified in 2024, 2 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
2
Licensed in
NC
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

190 Kimel Park Dr Ste 120
Winston Salem, NC 27103-6946
Phone: (336) 277-2200
Fax: (336) 277-2210
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-14581 (NC)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1053156521
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 27, 2024
Last updated in NPPESSeptember 17, 2024
Certification dateSeptember 17, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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