NPIMap

Organization Active NPI

Raleigh Durham Medical Group PA

  • Family Medicine Physician
  • Cary, NC
National Provider Identifier
1033160643
Registry record updated Sep 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RALEIGH DURHAM MEDICAL GROUP PA
Practice address
3700 NW Cary Pkwy
Cary, NC 27513-8422
Phone
(919) 238-2000
Fax
(919) 238-5010
NPI assigned
May 16, 2006
Organization subpart
Yes
Parent organization
RALEIGH DURHAM MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2007

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

Authorized official

Name
David K Moye
Title
Senior Vice President
Phone
(919) 851-2174

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X

Addresses

Primary practice location

3700 NW Cary Pkwy
Cary, NC 27513-8422

Mailing address

5400 Trinity Rd
Ste 105
Raleigh, NC 27607-6001
Phone (919) 851-2174

Other identifiers 1

IdentifierTypeStateIssuer
014RUOtherNCBCBS

Other names 1

  • Carolina Family Practice & Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000155 NC Part B Supplier - Clinic/Group Practice 2365409588 Receives reassigned benefits from 103 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Four Oaks, NC; Greenville, NC; Morrisville, NC; Raleigh, NC; Wake Forest, NC; Cary, NC; Fayetteville, NC…

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Raleigh Durham Medical

Locations

3700 NW Cary Pkwy
Cary, NC 27513
Phone (919) 319-3649

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1033160643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 TRINITY RD",
            "address_2": "STE 105",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076001",
            "telephone_number": "919-851-2174",
            "fax_number": "919-854-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 NW CARY PKWY",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138422",
            "telephone_number": "919-238-2000",
            "fax_number": "919-238-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "MOYE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "919-851-2174"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "014RU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Family Practice & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 21, 2007; 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.