Individual provider Active NPI

Heather Braddock Acevedo, M.D.

  • Pediatrics Physician
  • Wake Forest, NC
National Provider Identifier
1104146190
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
201301175 Issued in NC
Practice address
1655 Wake Dr Unit 101
Wake Forest, NC 27587-4746
Phone
(919) 556-4779
Fax
(919) 556-5277
NPI assigned
Jun 2, 2010
Last updated
Jan 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 201301175 NC Primary

Addresses

Primary practice location

1655 Wake Dr Unit 101
Wake Forest, NC 27587-4746

Mailing address

1655 Wake Dr Unit 101
Wake Forest, NC 27587-4746
Phone (919) 556-4779

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
I20190204002509 NC Practitioner - Pediatric Medicine 6406193192 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201301175NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Pediatric Associates, PLLC Pediatrics CurrentSince Oct 21, 2019 Accepting new patients
Wake Forest Pediatric Associates, PLLC Pediatrics Current Accepting new patients

Locations

6845 Knightdale Blvd
Ste 100
Knightdale, NC 27545
Phone (919) 266-5059

1655 Wake Dr
Unit 101
Wake Forest, NC 27587
Phone (919) 556-1541

Interoperability endpoints

  • Direct secure messaging: heatheracevedo@wfpapllc.allscriptsdirect.net

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1104146190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 WAKE DR UNIT 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874746",
            "telephone_number": "919-556-4779",
            "fax_number": "919-556-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 WAKE DR UNIT 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874746",
            "telephone_number": "919-556-4779",
            "fax_number": "919-556-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK ACEVEDO",
        "first_name": "HEATHER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "201301175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

Verify at the official NPI Registry.