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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | 1790343366 | 05 |
Other Name | Type Code |
---|---|
WakeMed Children's - Special Infant Care | Doing Business As Name - Organization |
WakeMed Childrens Special Infant Care | Other Name - Individual/Organization |
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 |
Entity Type | Entity Name | Entity Address |
---|---|---|
North Carolina Corporations | WakeMed Specialists Group LLC | 3000 New Bern Avenue, Raleigh, NC 27610 |
Street Address |
3024 NEW BERN AVE |
City | RALEIGH |
State | NC |
Zip Code | 27610-1247 |
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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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 Code | 2080N0001X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Neonatal-Perinatal Medicine |
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. |
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 |
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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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.