NPIMap

Organization Active NPI

Wakemed Specialists Group LLC

Doing business as WakeMed - Virtual Cardiac Rehab

  • Cardiac Rehabilitation Registered Nurse
  • Raleigh, NC
National Provider Identifier
1063304228
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiac Rehabilitation Registered NurseTaxonomy code 163WC3500X
Legal business name
WAKEMED SPECIALISTS GROUP LLC
Doing business as
WakeMed - Virtual Cardiac Rehab
Practice address
3000 New Bern Ave
Raleigh, NC 27610-1231
Phone
(919) 350-8000
NPI assigned
Jul 21, 2025
Last updated
Jul 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Authorized official

Name
Karen Revicki Perry
Title
Service Line Executive Director
Phone
(919) 350-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Registered Nurse 163WC3500X NU Primary

Addresses

Primary practice location

3000 New Bern Ave
Raleigh, NC 27610-1231

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0554

Other names 1

  • WakeMed - Virtual Cardiac Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251003001431 NC Part B Supplier - Intensive Cardiac Rehabilitation 2466788377 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, NC

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Wakemed Specialists Group L36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Wakemed

    dba WakeMed Mental Health & Well-Being Hospital WakeBrook

    • Psychiatric Hospital Unit
    • Raleigh, NC
    • NPI 1780446302

    Member Of

    NPD member

Locations

110 Kildaire Park Dr
Ste 101
Cary, NC 27518
Phone (919) 235-0616

110 Kildaire Park Dr
Ste 106
Cary, NC 27518
Phone (919) 235-0616

1110 SE Cary Pkwy
Cary, NC 27518
Phone (919) 235-6460

155 Parkway Office Ct
Cary, NC 27518
Phone (919) 859-4747

200 Ashville Ave
Cary, NC 27518
Phone (919) 232-5202

166 Springbrook Ave
Clayton, NC 27520
Phone (919) 350-4237

145 Tilghman Dr
Dunn, NC 28334
Phone (910) 891-7007

400 US 70 Hwy E
Ste 100
Garner, NC 27529

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3324 Six Forks Rd
Raleigh, NC 27609
Phone (919) 781-7772

3701 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 350-4199

1030 Siena Dr
Ste 120
Wake Forest, NC 27587

11640 Northpark Dr
Wake Forest, NC 27587
Phone (919) 234-4468

Practitioners & affiliated clinicians

Practitioners 1,320

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 1,320

NPI Registry JSON

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

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1063304228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0554",
            "fax_number": "919-350-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED SPECIALISTS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "REVICKI",
        "authorized_official_title_or_position": "SERVICE LINE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-350-8000"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed - Virtual Cardiac Rehab",
            "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 Jul 21, 2025; 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.