Individual provider Active NPI

Peter Conrad NG, MD

  • Surgery Physician
  • Raleigh, NC
National Provider Identifier
1063412377
Registry record updated Aug 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
200200427 Issued in NC
Practice address
1101 Dresser CT
Raleigh, NC 27609-7327
Phone
(919) 876-2010
Fax
(919) 954-0555
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 200200427 NC Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 200200427 NC

Addresses

Primary practice location

1101 Dresser CT
Raleigh, NC 27609-7327

Mailing address

1101 Dresser CT
Raleigh, NC 27609-7327
Phone (919) 876-2010

Other identifiers 2

IdentifierTypeStateIssuer
1318MOtherNCBCBS-NC
891318MMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090730000573 NC Practitioner - General Surgery 8123023090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Brody School of Medicine at East Carolina University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

4207 Lake Boone TRL
Raleigh, NC 27607-6684
Phone (919) 784-7874

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux13
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Carolina MG, LLC Surgery CurrentSince Jun 1, 2025 Accepting new patients
Rex Hospital Inc Past Accepting new patients
Rex Hospital, Inc. Past Accepting new patients

Locations

11200 Governor Manly Way
Ste 208
Raleigh, NC 27614

4207 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 780-0815

2800 Blue Ridge Rd
Ste 300
Raleigh, NC 27607
Phone (919) 784-8346

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

Interoperability endpoints

  • Direct secure messaging: png7006@direct.unc.nchie.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250035200000",
    "number": "1063412377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 DRESSER CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097327",
            "telephone_number": "919-876-2010",
            "fax_number": "919-954-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 DRESSER CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097327",
            "telephone_number": "919-876-2010",
            "fax_number": "919-954-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NG",
        "first_name": "PETER",
        "middle_name": "CONRAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2009-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "200200427",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NC",
            "license": "200200427",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC",
            "identifier": "1318M",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891318M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.