NPIMap

Organization Active NPI

Wakemed Specialists Group, LLC

  • Obesity Medicine (Internal Medicine) Physician
  • Cary, NC
National Provider Identifier
1013571587
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X
Legal business name
WAKEMED SPECIALISTS GROUP, LLC
Practice address
160 Macgregor Pines Dr
Cary, NC 27511-6036
Phone
(919) 234-4468
NPI assigned
Apr 30, 2019
Last updated
Sep 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shondra Lynn Brink
Title
VP, WPP
Phone
(919) 350-6045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Internal Medicine) Physician 207RB0002X NU Primary

Addresses

Primary practice location

160 Macgregor Pines Dr
Cary, NC 27511-6036

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010
Phone (919) 350-0554

Other names 1

  • WakeMed Bariatrics Surgery & Medical Weight Loss Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190731000815 NC Part B Supplier - Clinic/Group Practice 2466788377 Receives reassigned benefits from 1,327 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 47

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 47

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1013571587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 HIGHWOODS BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276040010",
            "telephone_number": "919-350-0554",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 MACGREGOR PINES DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275116036",
            "telephone_number": "919-234-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED SPECIALISTS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "BRINK",
        "authorized_official_first_name": "SHONDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, WPP",
        "authorized_official_telephone_number": "919-350-6045",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Bariatrics Surgery & Medical Weight Loss",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "WakeMed Bariatrics Surgery & Medical Weight Loss",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.