PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1790941755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790941755 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DURHAM REGIONAL HOSPITAL |
| Practice Address |
3643 N Roxboro St Durham NC 27704-2702 |
| Practice Telephone | 9194704000 |
| Mailing Telephone | 9194704000 |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2009-02-23 |
| Authorized Official Name | JOHN P DION (CFO) |
| Authorized Official Telephone | 9196848111 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIVATE DIAGNOSTIC CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
NC | Allopathic & Osteopathic Physicians | |
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
NC | Allopathic & Osteopathic Physicians | |
| N | 207V00000X | Obstetrics & Gynecology | NC | Allopathic & Osteopathic Physicians | |
| N | 363L00000X | Nurse Practitioner | NC | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 367A00000X | Advanced Practice Midwife | NC | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
NC | Allopathic & Osteopathic Physicians | |
| Y | 207R00000X | Internal Medicine | NC | Allopathic & Osteopathic Physicians | |
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5903564 | 05 |
| Other Name | Type Code |
|---|---|
| Durham Regional Hospital | Doing Business As Name - Organization |
| 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 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRIVATE DIAGNOSTIC CLINIC, PLLC | Duke University Medical Center, Durham, NC 27710-0001 |
| Street Address |
3643 N ROXBORO ST |
| City | DURHAM |
| State | NC |
| Zip Code | 27704-2702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033113899 | Nirmish Shah | Internal Medicine | 3643 N Roxboro St, Durham, NC 27704-2702 | 2005-06-09 |
| 1548872633 | Christopher James Rogge | Nurse Anesthetist, Certified Registered | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-08-19 |
| 1801404579 | Grace L Johnson | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-07-20 |
| 1174147102 | Kaitlyn Elizabeth Cockerham | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-06-05 |
| 1306466859 | Keri Laurelle Konstant | Registered Nurse | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-04-24 |
| 1194351262 | Deidre Pelletier | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-03-20 |
| 1720618812 | Elizabeth Parker Sulentic | Nurse Practitioner | 3643 N Roxboro St, Durham, NC 27704-2702 | 2020-01-17 |
| 1265079131 | Melinda Yvonne House | Nurse Practitioner | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-12-10 |
| 1427607811 | Grace Amy Revenaugh Dreyer | Physician Assistant | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-09-09 |
| 1841848934 | Ann Mei Lin | Hospitalist | 3643 N Roxboro St, Durham, NC 27704-2702 | 2019-08-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245723139 | Devang Ashokbhai Patel | Dentist | 2609 N Duke St Ste 618, Durham, NC 27704 | 2018-06-14 |
| 1891201042 | Little Family Care Home, LLC | Custodial Care Facility | 1012 Davinci Street, Durham, NC 27704 | 2017-12-26 |
| 1033625702 | Tondra A Little | Social Worker | 2804 Nellowood Street, Durham, NC 27704 | 2017-12-18 |
| 1437502408 | Jhazmere Shamas Preston | Counselor | 2609 N. Duke St. Suite 403, Durham, NC 27704 | 2016-07-14 |
| 1649626656 | Professional Elevations Pllc | Case Manager/Care Coordinator | 304 Crutchfield Drive, Durham, NC 27704 | 2016-05-09 |
| 1083071617 | Alyssa Wilson | Speech-Language Pathologist | 215 William Penn Plz Apt 908, Durham, NC 27704 | 2016-01-27 |
| 1932565124 | Arthur Reynolds Jr and Associates P.l.l.c. | Dentist | 2106 N Duke St, Durham, NC 27704 | 2016-01-05 |
| 1962877720 | Chimere Brooks | Contractor | 4001meriwether Drive Apt P-19, Durham, NC 27704 | 2015-12-04 |
| 1184013294 | Danielle King | Physician Assistant | 3611 N Duke Street, Durham, NC 27704 | 2015-01-13 |
| 1730581901 | Images, 'of Me To You' | Community/Behavioral Health | 2823 Cascadilla Street, Durham, NC 27704 | 2014-09-19 |
| Find all providers in zip 27704 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578077780 | Linda Heskestad Harpole | Internal Medicine | 3475 Erwin Rd Ste 200, Durham, NC 27705-0005 | 2017-11-27 |
| 1932629136 | Solomiia Savedchuk | Internal Medicine | 1000 Mcqueen Dr Apt 10102, Durham, NC 27705-8842 | 2017-06-20 |
| 1518344159 | Amanda Clark Coniglio | Internal Medicine | 2301 Erwin Rd # 3845, Durham, NC 27705 | 2015-05-04 |
| 1497141097 | Myung Woo | Internal Medicine | Duke University Hospital 40 Duke Medicine Circle, Durham, NC 27710 | 2015-04-09 |
| 1750701918 | Lana Wahid | Internal Medicine | 40 Duke Medicine Cir # 3534, Durham, NC 27710-4000 | 2014-04-25 |
| 1962822742 | Zachary Hager | Internal Medicine | 40 Medicine Circle Duke University Medical Center 3534, Durham, NC 27710-4872 | 2014-04-21 |
| 1316383243 | Nastassia Jennae Schenkel | Internal Medicine | Duke Primary Care Pickett Road, 3004 Tower Blvd, Durham, NC 27707 | 2013-05-19 |
| 1114360799 | James Stanley Howard | Internal Medicine | 2301 Erwin Rd Ste 1151, Durham, NC 27705 | 2013-04-12 |
| 1053651695 | John Morrison Macgregor | Internal Medicine | 92 Dover Rd, Durham, NH 03824-3318 | 2013-02-19 |
| 1649527714 | Duke University Affiliated Physicians, Inc. | Internal Medicine | 4020 Roxboro Rd, Durham, NC 27704 | 2012-08-08 |
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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.