Carly Marie Faller, MD
Individual provider Active NPI Internal Medicine Physician · Wilmington, NC
NPI 1144800244 · NPPES record last updated Jun 19, 2024
Key facts
- NPI
- 1144800244
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 2024-00476 (NC)
- Practice address
- 1124 Gallery Park LN
Wilmington, NC 28412-1142 - Phone
- (910) 341-3336
- NPI assigned
- Apr 12, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Nebraska College of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wilmington Health PLLC
Legacy Healthcare Services Inc
Practice addresses (Care Compare)
1124 Gallery Park LN
Wilmington, NC 28412-1142
Phone (910) 341-1540
2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600
Hospital & facility affiliations
- Well Care Home Health
- Liberty Home Care, LLC
- Novant Health New Hanover Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240909004433 | NC | Practitioner - Internal Medicine | 7012316078 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024-00476 | NC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilmington ASC LLC | Current |
Accepting new patients | |
| Wilmington Health PLLC | Current |
Accepting new patients | |
| Wha Medical Clinic PLLC | Current | Accepting new patients |
Locations
1124 Gallery Park Ln
Wilmington, NC 28412
Phone (910) 341-3389
1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705
Interoperability endpoints
- carly.faller.p1@direct.wilmingtonhealth.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2024-00476 | NC | Yes |
Addresses
Primary practice location
1124 Gallery Park LN
Wilmington, NC 28412-1142
Mailing address
1124 Gallery Park LN
Wilmington, NC 28412-1142
Phone (910) 341-3336
Other providers in Wilmington, NC
- Jennifer Faircloth
- Faith House, Inc
- Jenna Lynn Fike Falcinelli
- Carrie Ann Fales
- Sarah N Falk
- Curtis John Fallon Jr.
- Darby M Fallon
- Gilda Mary Falso
- Jessica Paige Fama
- Families for Families LLC
All providers in Wilmington, NC · Internal Medicine 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 Jun 19, 2024. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.