WAKEMED SPECIALISTS GROUP, LLC (NPI# 1174187637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174187637 |
| Entity Type | Organization |
| Organization Name | WAKEMED SPECIALISTS GROUP, LLC |
| Practice Address |
3000 New Bern Ave Raleigh NC 27610-1231 |
| Mailing Address |
2920 Highwoods Blvd Raleigh NC 27604-0010 |
| Practice Telephone | 9193508000 |
| Mailing Telephone | 9193500554 |
| Mailing Fax Number | 9193507687 |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |
| Authorized Official Name | MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 9193506089 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WakeMed Pediatric Intensivists | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326681164 | Wakemed Specialists Group, LLC | Durable Medical Equipment & Medical Supplies | 2930 Forestville Rd Ste 100, Raleigh, NC 27616-8774 | 2019-10-24 |
| 1407409543 | Wakemed Specialists Group, LLC | Pediatrics | 104 Medspring Dr, Clayton, NC 27520-9687 | 2019-07-18 |
| 1114582301 | Wakemed Specialists Group, LLC | Physical Therapist | 10010 Falls of Neuse Rd Ste 9, Raleigh, NC 27614-8495 | 2019-05-03 |
| 1376108522 | Wakemed Specialists Group, LLC | Orthopaedic Surgery | 8001 T W Alexander Dr Ste 224, Raleigh, NC 27617-4884 | 2019-05-03 |
| 1326684077 | Wakemed Specialists Group, LLC | Clinic/Center | 811 Us 70 Hwy W, Garner, NC 27529-2541 | 2019-11-18 |
| 1013552322 | Wakemed Specialists Group, LLC | Clinic/Center | 231 N Judd Pkwy Ne, Fuquay Varina, NC 27526-2694 | 2019-11-11 |
| 1588225759 | Wakemed Specialists Group, LLC | Preventive Medicine | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-06-27 |
| 1184289159 | Wakemed Specialists Group, LLC | Clinic/Center | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2019-05-06 |
| 1992360960 | Wakemed Specialists Group, LLC | Orthopaedic Surgery | 400 Us Highway 70 E, Ste 100, Garner, NC 27529-4850 | 2019-05-06 |
| 1720643927 | Wakemed Specialists Group, LLC | Otolaryngology | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| Street Address |
3000 NEW BERN AVE |
| City | RALEIGH |
| State | NC |
| Zip Code | 27610-1231 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508661 | George Rayburn Cheely | Internal Medicine | 3000 New Bern Ave, Ste 1200, Raleigh, NC 27610-1231 | 2005-06-17 |
| 1811507700 | Erika Barbosa Richard | Registered Nurse | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-05 |
| 1790395846 | Dana Sroka Thomson | Physical Therapist | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-04 |
| 1477163756 | Sarah Anne Schwisow | Registered Nurse | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-08-03 |
| 1831708486 | Andrew Yoon | Physician Assistant | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-07-29 |
| 1770104622 | Sonya Zaghloul | Speech-Language Pathologist | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-05-01 |
| 1871121269 | Bethany Shaffer Flinchum | Clinic/Center | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-31 |
| 1326674789 | Thomas Mellette | Dietitian, Registered | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-18 |
| 1457986234 | Rose Meitzen | Nurse Practitioner | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-03-11 |
| 1932733847 | Olga Sushkevich | Dietitian, Registered | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2020-02-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609499243 | Elizabeth Ranganai Mavindidze | Social Worker | Wakemed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610 | 2020-05-18 |
| 1851958839 | Alex & Associates, P.C. | Dentist | 1600 Cross Link Road, Unit 103, Raleigh, NC 27610 | 2019-05-24 |
| 1639646367 | Carol Mary Medins | Dietitian, Registered | Wakemed Raleigh Medical Park, 23 Sunnybrook Road, Suite 200, Raleigh, NC 27610 | 2018-10-31 |
| 1144714601 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 123 Sunnybrook Rd Ste 150, Raleigh, NC 27610 | 2018-06-19 |
| 1417446006 | Eagles Eye Lab, Inc | Clinical Medical Laboratory | 4501 New Bern Ave, Ste: 130, Raleigh, NC 27610 | 2018-05-09 |
| 1316465206 | Jeffery King Neer | Social Worker | 3010 Falstaff Rd., C/o Unc Actt, Raleigh, NC 27610 | 2017-08-31 |
| 1083139885 | Kelsey Daniel Mccleave | Social Worker | 3630 Enduring Freedom Drive, Raleigh, NC 27610 | 2017-08-14 |
| 1891219093 | Tarheel Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4840 Quarryman Road, Raleigh, NC 27610 | 2017-07-29 |
| 1508214826 | Compassionate Care Providers LLC | Respite Care | 5110 Wetlands, Raleigh, NC 27610 | 2016-05-26 |
| 1730552530 | Matthew Belair | Pharmacist | 1601-51 Cross Link Rd, Raleigh, NC 27610 | 2015-11-03 |
| Find all providers in zip 27610 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598010217 | Alan Kent Lassiter | Pediatrics | 10106 Raven Tree Dr, Raleigh, NC 27617-8206 | 2012-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538691514 | Christen Nicole Seaman | Pediatrics | 333 South Columbia Street, 230 Macnider Hall Cb #7593, Chapel Hill, NC 27599-0001 | 2017-03-30 |
| 1780021451 | Mousumee Shah | Pediatrics | Pediactric Education Ofc, 101 Manning Drive, Cb# 7593, Chapel Hill, NC 27599-0001 | 2013-06-04 |
| 1891057915 | Melissa Smith | Pediatrics | 417 Macnider, Chapel Hill, NC 27599 | 2012-06-14 |
| 1114110392 | Afsaneh Pirzadeh | Pediatrics | 214 Macnider Building, Cb # 7221, Chapel Hill, NC 27599-0001 | 2007-08-22 |
| 1477600286 | Jenny M Boyd | Pediatrics | 214 Macnider, Cb #7221, Chapel Hill, NC 27599-7221 | 2007-01-04 |
| 1770663726 | Stephen Leinenweber | Pediatrics | Duke Hospital South Trent Dr, Durham, NC 27710-0001 | 2006-10-16 |
| 1417904889 | David A Turner | Pediatrics | 2300 Erwin Road, Durham, NC 27710 | 2006-05-30 |
| 1124086814 | Childrens Acute Care of Fayetteville, P.a. | Pediatrics | 1638 Owen Dr - Picu, Fayetteville, NC 28304-3424 | 2006-05-02 |
| 1982092219 | Coastal Childrens Services Pllc | Pediatrics | 2131 S 17th St, Wilmington, NC 28401-7407 | 2015-01-09 |
| 1093157828 | Kathryn Anne Best | Pediatrics | 2100 Stantonsburg Rd, Greenville, NC 27834-2818 | 2013-07-22 |
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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.