WAKEMED SPECIALISTS GROUP LLC


Address: 3024 New Bern Ave, Raleigh, NC 27610-1247
Phone: 9193507846

WAKEMED SPECIALISTS GROUP LLC (NPI# 1790343366) 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) 1790343366
Entity Type Organization
Organization Name WAKEMED SPECIALISTS GROUP LLC
Other Organization Name WAKEMED CHILDRENS SPECIAL INFANT CARE
Practice Address 3024 New Bern Ave
Raleigh
NC 27610-1247
Mailing Address Po Box 603949
Charlotte
NC 28260-3949
Practice Telephone 9193507846
Practice Fax Number 9193508147
Mailing Telephone 9193500552
Mailing Fax Number 9193507687
Enumeration Date 2019-05-30
Last Update Date 2019-08-19
Authorized Official Name MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE)
Authorized Official Telephone 9193506089
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 208000000X Pediatrics Allopathic & Osteopathic Physicians
Y 2080N0001X Pediatrics
Specialization: Neonatal-Perinatal Medicine
Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NC 1790343366 05

Other Provider/Organization Names

Other Name Type Code
WakeMed Children's - Special Infant Care Doing Business As Name - Organization
WakeMed Childrens Special Infant Care Other Name - Individual/Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1811522089 Wakemed Specialists Group LLC Internal Medicine 300 Keisler Dr, Cary, NC 27518-7083 2020-03-09
1497307334 Wakemed Specialists Group LLC Pediatrics 23 Sunnybrook Rd, Raleigh, NC 27610-1855 2019-07-11
1225693419 Wakemed Specialists Group LLC Surgery 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1417512690 Wakemed Specialists Group LLC Orthopaedic Surgery 3009 New Bern Ave, Raleigh, NC 27610-1214 2019-05-03
1205491487 Wakemed Specialists Group LLC Urology 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1205491495 Wakemed Specialists Group LLC Internal Medicine 3000 New Bern Ave, Raleigh, NC 27610-1231 2019-05-03
1386209633 Wakemed Specialists Group LLC Clinic/Center 2406 Blue Ridge Rd, Raleigh, NC 27607-6678 2019-05-02
1073178398 Wakemed Specialists Group LLC Internal Medicine 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 2019-05-02
1518521905 Wakemed Specialists Group LLC Obstetrics & Gynecology 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 2019-05-01
1255995643 Wakemed Specialists Group LLC Family Medicine 2820 Kidd Rd, Raleigh, NC 27610-1842 2019-05-01

Other Data Sources

Entity Type Entity Name Entity Address
North Carolina Corporations WakeMed Specialists Group LLC 3000 New Bern Avenue, Raleigh, NC 27610

Office Location

Street Address 3024 NEW BERN AVE
City RALEIGH
State NC
Zip Code 27610-1247

Providers in the same location

NPI Name Taxonomy Address Enumeration
1588664924 Lynn M Rebello Pediatrics 3024 New Bern Ave, Raleigh, NC 27610 2005-07-28
1275158206 Alejandro Ramirez Lopez Physician Assistant 3024 New Bern Ave, Raleigh, NC 27610-1247 2020-06-16
1588225759 Wakemed Specialists Group, LLC Preventive Medicine 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-06-27
1821659079 Sharon Elizabeth Booth Physician Assistant 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-06-27
1225693419 Wakemed Specialists Group LLC Surgery 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1720643927 Wakemed Specialists Group, LLC Otolaryngology 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1649835836 Wakemed Specialists Group, LLC Internal Medicine 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1205491487 Wakemed Specialists Group LLC Urology 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1639734817 Wakemed Specialists Group, LLC Nutritionist 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-03
1821653288 Wakemed Specialists Group, LLC Anesthesiology 3024 New Bern Ave, Raleigh, NC 27610-1247 2019-05-01
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 2080N0001X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics
Specialization Neonatal-Perinatal Medicine

Taxonomy Definition

A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1770568172 Stephen Frederick Parsons Pediatrics 1909 Saint Marys St, Raleigh, NC 27608-2224 2005-12-08
1649834102 Wakemed Specialists Group, LLC Pediatrics 3000 New Bern Ave, Raleigh, NC 27610-1231 2019-04-30
1760772834 Laura Elizabeth Edwards Pediatrics 3000 New Bern Ave, Raleigh, NC 27610-1231 2011-04-11
1639338080 Claudia Tolentino Cadet Pediatrics 4420 Lake Boone Trl, Department of Neonatology, Raleigh, NC 27607-7505 2008-06-02
1063421345 Stephen Downer Kicklighter Pediatrics 3000 New Bern Ave, Neonatology Dept., Raleigh, NC 27610-1231 2006-08-05
1821053034 Marie Emmanuela Ambroise Thigpen Pediatrics 4420 Lake Boone Trl, Raleigh, NC 27607-7505 2006-04-19

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1396181764 Erin Elizabeth Hayes Orth Pediatrics 1121 North Church Street, Greensboro, NC 27401 2013-05-13
1518202969 Ronald Paul Gregoire Pediatrics 207 Cabbage Inlet Ln, Wilmington, NC 28409-3004 2012-12-11
1225396690 Wesley Matthew Jackson Pediatrics 5801 Mountain Island Dr, Durham, NC 27713-8909 2012-04-24
1982915179 Jennifer Lee Nash Holman Pediatrics Wfsm Department of Pediatrics, Medical Center Boulevard, Winston Salem, NC 27157-1081 2010-06-23
1306023742 Scott Allan Witt Pediatrics Duke University Medical Center Department of Pediatrics, Dumc Box 3179, Durham, NC 27710-0001 2008-01-29
1386827335 Piedmont Neonatology PC Pediatrics 628 Green Valley Road, Suite 210, Greensboro, NC 27408-7789 2007-12-13
1508959420 Neonatology Services of Hickory, Pllc Pediatrics 352 2nd St. Nw, Suite #205, Hickory, NC 28601 2006-10-02
1104840248 Roy Schneiderman Pediatrics 655 Lake Dornoch Drive, Pinehurst, NC 28374-7135 2006-07-26
1588617948 Usha Doshi Pediatrics 101 Maynard Crossing Ct, N/a, Cary, NC 27513-8723 2006-05-18
1689634792 Christie C. Davanzo Pediatrics 628 Green Valley Rd, Suite 210, Greensboro, NC 27408-7730 2006-03-23
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Competitor

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City RALEIGH
Zip Code 27610

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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