NPIMap

Individual provider Active NPI

Carly Marie Faller, MD

  • Internal Medicine Physician
  • Wilmington, NC
National Provider Identifier
1144800244
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2024-00476 Issued in NC
Practice address
1124 Gallery Park LN
Wilmington, NC 28412-1142
Phone
(910) 341-3336
NPI assigned
Apr 12, 2021
Last updated
Jun 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2024-00476 NC Primary

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

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
I20240909004433 NC Practitioner - Internal Medicine 7012316078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 PLLCGroup PAC ID 6103722509, 364 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2024-00476NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wha Medical Clinic PLLC Current Accepting new patients
Wilmington ASC LLC CurrentSince Sep 3, 2024 Accepting new patients
Wilmington Health PLLC CurrentSince Sep 3, 2024 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

  • Direct secure messaging: carly.faller.p1@direct.wilmingtonhealth.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1144800244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 GALLERY PARK LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284121142",
            "telephone_number": "910-341-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 GALLERY PARK LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284121142",
            "telephone_number": "910-341-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLER",
        "first_name": "CARLY",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2024-00476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.