Individual provider Active NPI

Samuel M Wesonga, MD

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1114911823
Registry record updated Apr 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9300369 Issued in NC
Practice address
8001 T W Alexander Dr Ste 216
Raleigh, NC 27617-4884
Phone
(919) 350-0953
Fax
(193) 509-8189
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 93-00369 NC
Family Medicine Physician 207Q00000X 9300369 NC Primary

Addresses

Primary practice location

8001 T W Alexander Dr Ste 216
Raleigh, NC 27617-4884

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010
Phone (877) 498-4490

Other practice location 1

921 N. Winstead Avenue
Rocky Mount, NC 27804
Phone (252) 937-0300

Other identifiers 5

IdentifierTypeStateIssuer
80084731OtherNCRAILROAD MEDICARE
8986588MedicaidNC
59381OtherNCMEDCOST
86588OtherNCBCBSNC
5497949OtherNCCIGNA HEALTHCARE

Other names 1

  • Sam Wesonga Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address swesonga236701@directHISP.wakemed.org Direct

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
I20060114000085 NC Practitioner - Family PracticePractitioner - General Practice 7517981749 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians
Wake Specialty Physicians LLCGroup PAC ID 7416006085, 178 clinicians

Practice addresses (Care Compare)

2303 Wellington Dr SW
Suite B
Wilson, NC 27893-8620
Phone (252) 243-6818

8001 T W Alexander Dr
Raleigh, NC 27617-4883
Phone (919) 350-0953

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
93-00369NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group, LLC CurrentSince Aug 22, 2019 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Aug 22, 2019 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients
Wake Specialty Physicians LLC CurrentSince Oct 1, 2018 Accepting new patients
Wake Specialty Physicians, LLC CurrentSince Oct 1, 2018 Accepting new patients
Boice-Willis Clinic PA Family Medicine Current Accepting new patients
Wake Specialty Physicians, LLC Family Medicine Current Accepting new patients

Locations

222 Ashville Ave
Cary, NC 27518
Phone (919) 576-2330

231 N Judd Pkwy NE
Fuquay Varina, NC 27526
Phone (919) 235-6410

2920 Highwoods Blvd
Raleigh, NC 27604

8001 T W Alexander Dr
Ste 216
Raleigh, NC 27617
Phone (919) 350-0953

8001 T W Alexander Dr
Raleigh, NC 27617
Phone (919) 350-0953

10000 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1630

10010 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1380

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

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

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

901 N Winstead Ave
Rocky Mount, NC 27804
Phone (252) 937-0200

921 N Winstead Ave
Rocky Mount, NC 27804
Phone (252) 937-0300

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

Interoperability endpoints

  • Direct secure messaging: swesonga236701@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.

Hospital & facility affiliations 3

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1114911823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 HIGHWOODS BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276040010",
            "telephone_number": "877-498-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 T W ALEXANDER DR STE 216",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276174884",
            "telephone_number": "919-350-0953",
            "fax_number": "193-509-8189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 N. Winstead Avenue",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "27804",
            "country_code": "US",
            "telephone_number": "252-937-0300",
            "fax_number": "252-937-2675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WESONGA",
        "first_name": "SAMUEL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "93-00369",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9300369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "80084731",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8986588",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "59381",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "86588",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "5497949",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swesonga236701@directHISP.wakemed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "xml",
            "address_1": "8001 T W Alexander Dr Ste 216",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276174884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAM",
            "last_name": "WESONGA",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.