WAKEMED SPECIALISTS GROUP LLC (NPI# 1811522089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811522089 |
| Entity Type | Organization |
| Organization Name | WAKEMED SPECIALISTS GROUP LLC |
| Practice Address |
300 Keisler Dr Cary NC 27518-7083 |
| Mailing Address |
Po Box 603949 Charlotte NC 28260-3949 |
| Practice Telephone | 9192330059 |
| Practice Fax Number | 9192330343 |
| Mailing Telephone | 9193500552 |
| Mailing Fax Number | 9193507687 |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2020-03-09 |
| 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 | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WakeMed Cary Cardiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497307334 | Wakemed Specialists Group LLC | Pediatrics | 23 Sunnybrook Rd, Raleigh, NC 27610-1855 | 2019-07-11 |
| 1790343366 | Wakemed Specialists Group LLC | Pediatrics | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-30 |
| 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 |
300 KEISLER DR |
| City | CARY |
| State | NC |
| Zip Code | 27518-7083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679561369 | Priyavadan Maneklal Shah | Internal Medicine | 300 Keisler Dr, Suite 204, Cary, NC 27511-7083 | 2005-10-07 |
| 1073121265 | Laiby Boban | Nurse Practitioner | 300 Keisler Dr, Cary, NC 27518-7083 | 2020-07-14 |
| 1104200815 | Heather Santori | Nurse Practitioner | 300 Keisler Dr, Cary, NC 27518-7083 | 2015-07-13 |
| 1558772574 | Wake Specialty Physicians,llc | Internal Medicine | 300 Keisler Dr, Cary, NC 27518-7083 | 2014-05-13 |
| 1891130415 | Sarah Willis Tiesing | Nurse Practitioner | 300 Keisler Dr, Suite 204, Cary, NC 27518-7083 | 2013-05-09 |
| 1053559641 | Michelle Lyn Kuerbitz | Nurse Practitioner | 300 Keisler Dr, Suite 204, Cary, NC 27518-7083 | 2009-02-04 |
| 1255578415 | Cary Cardiology Associates | Non-Pharmacy Dispensing Site | 300 Keisler Dr, 200, Cary, NC 27518-7083 | 2009-01-09 |
| 1316101876 | Wake Plastic Surgery, Pllc | Clinic/Center | 300 Keisler Dr, Suite 102, Cary, NC 27518-7083 | 2008-07-14 |
| 1629240395 | Pavlo I Netrebko | Internal Medicine | 300 Keisler Dr, Suite 204, Cary, NC 27518-7083 | 2008-04-02 |
| 1477734077 | William Todd Stoeckel | Plastic Surgery | 300 Keisler Dr, Suite 102, Cary, NC 27518-7083 | 2007-11-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932730801 | Fuller & Associates Iv, Pllc | Dentist | 3420 Ten-ten Road, Suite 310, Cary, NC 27518 | 2020-01-30 |
| 1649761602 | Uday N Reebye, Md. Dmd, Pa | Dentist | 431 Keisler Dr Ste 101, Cary, NC 27518 | 2018-05-25 |
| 1164912093 | Cary Dental Rejuvenation | Dentist | 155 Parkway Office Court, Suite 104, Cary, NC 27518 | 2018-05-16 |
| 1104337021 | Kaylah Mckinley Black | Nurse Practitioner | 530 New Waverly Pl Ste 301, Cary, NC 27518 | 2017-10-18 |
| 1013442961 | Amber Pinsky | Occupational Therapist | 5310 Woodfield Lake Road, Cary, NC 27518 | 2017-04-28 |
| 1750733564 | Maureen Lyons Reardon | Psychologist | 2500 Regency Parkway, Cary, NC 27518 | 2016-07-05 |
| 1730539651 | Anna Liakh | Dentist | 8204 Tryon Woods Dr, Cary, NC 27518 | 2016-06-21 |
| 1609236173 | Matthew John Myschisin II | Chiropractor | 4312 Farm Brook Dr, Cary, NC 27518 | 2016-02-26 |
| 1003299405 | Amanda Lee Morris | Social Worker | 531 Keisler Dr Ste 104, Cary, NC 27518 | 2015-07-02 |
| 1053791343 | Duke University Affiliated Physicians | Family Medicine | 530 Waverly Place, Suite 101, Cary, NC 27518 | 2015-06-02 |
| Find all providers in zip 27518 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://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 |
|---|---|---|---|---|
| 1932505294 | Donald Frederick Fortin | Internal Medicine | 14001 Weston Pkwy, Suite 101, Cary, NC 27513-2255 | 2014-11-14 |
| 1235366634 | Kamal Kumar Padmanabhan Kolappa | Internal Medicine | 7560 Carpenter Fire Station Rd, Cary, NC 27519-8616 | 2009-06-12 |
| 1740364447 | Alison Arnold | Internal Medicine | 402 Panorama Park Pl, Cary, NC 27519-0857 | 2006-10-25 |
| 1679561369 | Priyavadan Maneklal Shah | Internal Medicine | 300 Keisler Dr, Suite 204, Cary, NC 27511-7083 | 2005-10-07 |
| 1790208981 | Triangle Cardiology, Pllc | Internal Medicine | 7560 Carpenter Fire Station Rd, Cary, NC 27519-8616 | 2017-07-20 |
| 1558772574 | Wake Specialty Physicians,llc | Internal Medicine | 300 Keisler Dr, Cary, NC 27518-7083 | 2014-05-13 |
| 1629240395 | Pavlo I Netrebko | Internal Medicine | 300 Keisler Dr, Suite 204, Cary, NC 27518-7083 | 2008-04-02 |
| 1013940295 | Private Diagnostic Clinic, Pllc | Internal Medicine | 3700 Nw Cary Pkwy, Suite 100, Cary, NC 27513-8446 | 2006-07-09 |
| 1780661033 | Joshua C Macomber | Internal Medicine | 300 Keisler Dr, Suite 204, Cary, NC 27511-7083 | 2005-12-28 |
| 1982681417 | Bhavani Balaravi | Internal Medicine | 300 Ashville Ave, Suite 301, Cary, NC 27518-8682 | 2005-12-27 |
| Find all providers in CARY | ||||
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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.