PRIVATE DIAGNOSTIC CLINIC, PLLC


Address: 5620 Six Forks Rd, Suite 104, Raleigh, NC 27609-8619
Phone: 9196848111

PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1447283619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1447283619
Entity Type Organization
Organization Name PRIVATE DIAGNOSTIC CLINIC, PLLC
Other Organization Name CAROLINA ORTHOPAEDICS & SPORTS MEDICINE
Practice Address 5620 Six Forks Rd
Suite 104
Raleigh
NC 27609-8619
Mailing Address Po Box 63362
Charlotte
NC 28263-3362
Practice Telephone 9196848111
Mailing Telephone 9196848111
Enumeration Date 2006-07-09
Last Update Date 2011-12-08
Authorized Official Name MR. MARK L CANTRELL (CHIEF PRIVACY & COMPLIANCE OFFICER)
Authorized Official Telephone 9196685161
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207XX0005X Orthopaedic Surgery
Specialization: Sports Medicine
Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NC 890263G 05
NC GROUP 0263G 01

Other Provider/Organization Names

Other Name Type Code
Carolina Orthopaedics & Sports Medicine Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1538616289 Private Diagnostic Clinic, Pllc Neurological Surgery 1212 Cedarhurst Dr Ste 102, Raleigh, NC 27609-5588 2016-09-09
1083168181 Private Diagnostic Clinic, Pllc Internal Medicine 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 2016-08-08
1124459292 Private Diagnostic Clinic, Pllc Occupational Therapist Duke Clinic 1e, 40 Duke Medicine Circle, Durham, NC 27710-0001 2013-11-27
1609116664 Private Diagnostic Clinic, Pllc Dermatology 82 Wheaton Ave, Youngsville, NC 27596-8691 2013-02-27
1487903423 Private Diagnostic Clinic, Pllc Pediatrics 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 2012-09-06
1558639864 Private Diagnostic Clinic, Pllc Allergy & Immunology 30 Duke Medicine Circle, Durham, NC 27710-3000 2011-12-01
1972826568 Private Diagnostic Clinic, Pllc Family Medicine 800 Clayton Rd, Durham, NC 27703-2606 2010-03-10
1891021853 Private Diagnostic Clinic, Pllc Obstetrics & Gynecology 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 2009-10-27
1447480413 Private Diagnostic Clinic, Pllc Orthopaedic Surgery 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 2009-07-23
1841446762 Private Diagnostic Clinic, Pllc Otolaryngology 783 Doctors Ct Ste C, Roxboro, NC 27573-4575 2008-08-12

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities PRIVATE DIAGNOSTIC CLINIC, PLLC Duke University Medical Center, Durham, NC 27710-0001

Office Location

Street Address 5620 SIX FORKS RD
SUITE 104
City RALEIGH
State NC
Zip Code 27609-8619

Providers in the same location

NPI Name Taxonomy Address Enumeration
1336287283 Private Diagnostic Clinic, Pllc Durable Medical Equipment & Medical Supplies 5620 Six Forks Rd, Raleigh, NC 27609-8619 2007-02-02

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1184235582 Choice Service Solutions LLC In Home Supportive Care 5300 Six Fox Rd Siite205, Raleigh, NC 27609 2020-08-11
1003426073 Rosana Oba -rovira Registered Nurse 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 2020-08-05
1821612706 Helen Alexandra Bonner Physical Medicine & Rehabilitation Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 2020-06-05
1215423579 Appiah Nana Larbi Social Worker Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 2018-07-10
1215423777 Broadway Home Care LLC In Home Supportive Care 107 Windel Dr Ste 105, Raleigh, NC 27609 2018-07-09
1275027948 Lacey Allene Cottingham Social Worker 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 2018-06-18
1447748819 Integrated Dermatology of North Raleigh, Pllc Dermatology 3809 Computer Dr Ste 200, Raleigh, NC 27609 2018-05-01
1902325418 Naomi Christine Askew Nurse Practitioner 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 2017-09-15
1962929679 Alexia Montague Social Worker 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 2017-08-23
1730602236 Chantel Washington-mbuthia Counselor 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 2017-07-18
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Taxonomy Information

Taxonomy Code 207XX0005X
Grouping Allopathic & Osteopathic Physicians
Classification Orthopaedic Surgery
Specialization Sports Medicine

Taxonomy Definition

An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1477736155 Impact Orthopaedics, Pa Orthopaedic Surgery 3320 Wake Forest Rd, Suite 120, Raleigh, NC 27609-7300 2007-12-17
1871776807 Robert Glen Jones Orthopaedic Surgery 3801 Wake Forest Rd Ste 220, Raleigh, NC 27609-6864 2007-12-13
1417948365 Lee Harold Diehl Orthopaedic Surgery 1108 Dresser Ct, Raleigh, NC 27609-7328 2005-10-31

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1902241805 Ian Al'khafaji Orthopaedic Surgery 2719 Reynolda Rd, Winston Salem, NC 27106 2013-05-06
1821354812 Sunny Patel Orthopaedic Surgery 1234 Huffman Mill Rd Dept Of, Burlington, NC 27215 2012-04-04
1174763981 Brett Andrew Fritsch Orthopaedic Surgery Duke Sports Medicine Ctr, 300 Frank Bassett Drive, Durham, NC 27710-0001 2009-03-06
1033366885 Scotland Orthopedics, Pa Orthopaedic Surgery 410 D South Jones Street, Pembroke, NC 28372 2008-08-23
1437315165 North Carolina Shoulder and Elbow Surgery and Sports Medicine Orthopaedic Surgery 900 North Howe St, Southport, NC 28461 2008-08-01
1750542411 Abby B. Maxwell Orthopaedic Surgery 3 Mcdowell St, Suite B, Asheville, NC 28801-4103 2008-06-24
1518130418 Jeffrey Tweed Spang Orthopaedic Surgery University of North Carolina Hospital, Cb# 7055, Chapel Hill, NC 27599-7055 2008-04-11
1184746810 Kevin Leo Krasinski Orthopaedic Surgery 1236 Huffman Mill Rd Ste 1300, Burlington, NC 27215-8700 2007-04-04
1285748970 Statesville Hma Physician Management, Inc Orthopaedic Surgery 340 Signal Hill Dr, Suite A, Statesville, NC 28625-4357 2006-08-18
1467461566 Timothy Ned Taft Orthopaedic Surgery 3154 Bioinformatics Bldg, Cb # 7055 Unc, Chapel Hill, NC 27599-0001 2006-08-07
Find all providers with the same taxonomy

Competitor

Search similar providers

City RALEIGH
Zip Code 27609

Improve Information

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Dataset Information

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.

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