NPIMap

Individual provider Active NPI

Reza John Hatefi, PAC

  • Physician Assistant
  • Wake Forest, NC
National Provider Identifier
1114960036
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
NC 103020 Issued in NC
Practice address
2001 S Main St
Wake Forest, NC 27587-1649
Phone
(919) 350-0365
NPI assigned
Jun 14, 2006
Last updated
Feb 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NC 103020 NC Primary

Addresses

Primary practice location

2001 S Main St
Wake Forest, NC 27587-1649

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhatefi316495@directHISP.wakemed.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040211000467 NC Practitioner - Physician Assistant 0840184875 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Medical Services, PLLCGroup PAC ID 4688912652, 6 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

10931 Raven Ridge Rd
Suite 115
Raleigh, NC 27614-6499
Phone (919) 676-0202

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
NC 103020NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Dec 15, 2020 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Dec 15, 2020 Accepting new patients
Wake Specialty Physicians LLC CurrentSince Oct 1, 2020 Accepting new patients
Wake Specialty Physicians LLC CurrentSince Oct 1, 2020 Accepting new patients
Clayton Urgent Care and Family Clinic PA Past Accepting new patients
Wake Specialty Physicians LLC PastSince Nov 8, 2025 Accepting new patients
Cross Creek Urgent Care and Family Clinic Past Accepting new patients
North Carolina Em-I Medical Services PC Physician Assistant Past Accepting new patients
Fastmed Urgent Care PC Past Accepting new patients
Laurel Mill Emergency Physicians Past Accepting new patients

Locations

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

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

509 N Brightleaf Blvd
Smithfield, NC 27577
Phone (919) 934-8171

2001 S Main St
Wake Forest, NC 27587
Phone (919) 562-3155

Interoperability endpoints

  • Direct secure messaging: rhatefi316495@directhisp.wakemed.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1114960036",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S MAIN ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275871649",
            "telephone_number": "919-350-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATEFI",
        "first_name": "REZA",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "NC 103020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhatefi316495@directHISP.wakemed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "2001 S Main St",
            "city": "Wake Forest",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275871649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

Verify at the official NPI Registry.