NPIMap

Organization Active NPI

Wake Specialty Phisicians, LLC

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1053921874
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WAKE SPECIALTY PHISICIANS, LLC
Practice address
601 Oberlin Rd
Raleigh, NC 27605-1126
Phone
(919) 235-6566
Fax
(919) 235-6532
NPI assigned
Aug 6, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Shondra Lynn Brink
Title
VP, WPP Operations
Phone
(919) 350-6045

Other NPIs on the same Medicare enrollment 43

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

View all 43

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2189077Wakemed Primary Care601 Oberlin Rd, Raleigh, NC 27605Provider-performed microscopyJul 26, 2028

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20090601000520 NC Part B Supplier - Clinic/Group Practice 7416006085 Receives reassigned benefits from 283 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Falls Pointe Medical Group (70 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

NPPES NPI Registry

Primary practice location

601 Oberlin Rd
Raleigh, NC 27605-1126

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0554

Other names 1

NPPES NPI Registry
  • WakeMed Primary Care Oberlin Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 14, 2021.

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610582400000",
    "number": "1053921874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "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": "601 OBERLIN RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276051126",
            "telephone_number": "919-235-6566",
            "fax_number": "919-235-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHISICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-06",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "BRINK",
        "authorized_official_first_name": "SHONDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, WPP OPERATIONS",
        "authorized_official_telephone_number": "919-350-6045"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Primary Care Oberlin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.