Wakemed Specialists Group LLC
Organization Active NPI Surgery Physician · Cary, NC
NPI 1104499474 · NPPES record last updated Jul 23, 2021
Key facts
- NPI
- 1104499474
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- WAKEMED SPECIALISTS GROUP LLC
- Practice address
- 115 Parkway Office CT
Cary, NC 27518-7430 - Phone
- (919) 859-4747
- Fax
- (919) 859-4757
- NPI assigned
- Jul 23, 2021
- Organization subpart
- No
Authorized official
- Name
- Shondra Lynn Brink
- Title
- VP, WPP Operations
- Phone
- (919) 350-6045
Other NPIs on the same Medicare enrollment 47
Corporate family (same tax ID) 35
Practitioners 6
-
Erin Kathleen McConahy, PA-C
-
Melissa Rogers, PA-C
-
Andrew C Slocum, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190731000815 | NC | Part B Supplier - Clinic/Group Practice | 2466788377 |
Receives reassigned benefits from 1,327 practitioners 47 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Wakemed Specialists Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
115 Parkway Office CT
Cary, NC 27518-7430
Mailing address
PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0554
Other names
- Western Wake Surgical
NPI Registry JSON
{
"created_epoch": "1626998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626998400000",
"number": "1104499474",
"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": "919-350-7867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 PARKWAY OFFICE CT",
"city": "CARY",
"state": "NC",
"postal_code": "275187430",
"telephone_number": "919-859-4747",
"fax_number": "919-859-4757"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WAKEMED SPECIALISTS GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-07-23",
"last_updated": "2021-07-23",
"certification_date": "2021-07-23",
"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": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Western Wake Surgical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cary, NC
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All providers in Cary, NC · Surgery Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.