Individual provider Active NPI

Timothy Paul Bukowski, MD

  • Pediatric Urology Physician
  • Raleigh, NC
National Provider Identifier
1104843556
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
9500849 Issued in NC
Practice address
3821 Ed Dr
Raleigh, NC 27612-8038
Phone
(919) 851-5482
Fax
(919) 859-1729
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 9500849 NC
Pediatric Urology Physician 2088P0231X 9500849 NC Primary

Addresses

Primary practice location

3821 Ed Dr
Raleigh, NC 27612-8038

Mailing address

3821 Ed Dr
Raleigh, NC 27612-8038
Phone (919) 851-5482

Other identifiers 1

IdentifierTypeStateIssuer
8919639MedicaidNC

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
I20040116000808 NC Practitioner - UrologyPractitioner - General Surgery 7416858964 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
State University of New York at Buffalo School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

3024 New Bern Ave
Raleigh, NC 27610-1247
Phone (919) 350-7856

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9500849NCMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Apr 5, 2021 Accepting new patients
Wakemed Specialists Group LLC Urology CurrentSince Apr 5, 2021 Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Aug 17, 2010 Accepting new patients
Wakemed Specialists Group, LLC Urology Current Accepting new patients
North Carolina Urological Associates, Inc Urology Current Accepting new patients
Wakemed Faculty Practice Plan Past Accepting new patients
Wakemed Faculty Practice Plan Urology Past Accepting new patients

Locations

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

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

3024 New Bern Ave
Ste 300
Raleigh, NC 27610
Phone (919) 350-8228

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

2800 Blue Ridge Rd
Ste 405
Raleigh, NC 27607
Phone (919) 784-6818

3024 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-5318

2406 Blue Ridge Rd
Ste 190
Raleigh, NC 27607
Phone (919) 594-1198

1030 Siena Dr
Wake Forest, NC 27587
Phone (919) 235-6511

Interoperability endpoints

  • Direct secure messaging: tbukowski11739@direct.unc.nchie.net
  • Direct secure messaging: tbukowski50175@directhisp.wakemed.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1104843556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3821 ED DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128038",
            "telephone_number": "919-851-5482",
            "fax_number": "919-859-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3821 ED DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128038",
            "telephone_number": "919-851-5482",
            "fax_number": "919-859-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUKOWSKI",
        "first_name": "TIMOTHY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "9500849",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NC",
            "license": "9500849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8919639",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.