NPIMap

Individual provider Active NPI

Kristopher Wyatt Decker, PA-C

  • Physician Assistant
  • Cary, NC
National Provider Identifier
1154795227
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08659 Issued in NC
Practice address
222 Ashville Ave Ste 10
Cary, NC 27518-6130
Phone
(919) 859-1136
NPI assigned
Nov 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3643-23 WI
Physician Assistant 363A00000X 0010-08659 NC Primary

Addresses

Primary practice location

222 Ashville Ave Ste 10
Cary, NC 27518-6130

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010

Other practice location 1

2406 Blue Ridge Rd Ste 190
Raleigh, NC 27607-6680
Phone (919) 789-4322

Other practice location 2

2930 Forestville Rd
Raleigh, NC 27616-8774
Phone (919) 235-6550

Other practice location 3

811 US 70 Hwy W
Garner, NC 27529-2541
Phone (919) 235-6565

Other practice location 4

231 N Judd Pkwy NE
Fuquay Varina, NC 27526-2694
Phone (919) 235-6410

Other identifiers 3

IdentifierTypeStateIssuer
085-005532OtherILSTATE OF IL
0010-08659OtherNCSTATE OF NC
3643-23OtherWISTATE OF WI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kdecker261613@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
I20191001002688 NC Practitioner - Physician Assistant 3274834171 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
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)

231 N Judd Pkwy NE
Fuquay Varina, NC 27526-2694
Phone (919) 232-0322

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

  • Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-08659NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
CDT Healthcare CurrentSince Nov 19, 2019 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Aug 26, 2019 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Aug 26, 2019 Accepting new patients
Froedtert South, Inc. Past Accepting new patients

Locations

222 Ashville Ave
Ste 10
Cary, NC 27518
Phone (919) 233-6000

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

811 US 70 Hwy W
Garner, NC 27529
Phone (919) 235-6565

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

2920 Highwoods Blvd
Raleigh, NC 27604

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

2930 Forestville Rd
Raleigh, NC 27616
Phone (919) 235-6500

101 Walmart Supercenter
Siler City, NC 27344
Phone (919) 663-3911

Interoperability endpoints

  • Direct secure messaging: kdecker261613@directhisp.wakemed.org

Organizations & group practices 12

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 2

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": "1448841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1154795227",
    "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": "222 ASHVILLE AVE STE 10",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186130",
            "telephone_number": "919-859-1136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2406 Blue Ridge Rd Ste 190",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276076680",
            "country_code": "US",
            "telephone_number": "919-789-4322",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2930 Forestville Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276168774",
            "country_code": "US",
            "telephone_number": "919-235-6550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "811 US 70 Hwy W",
            "address_purpose": "LOCATION",
            "city": "Garner",
            "state": "NC",
            "postal_code": "275292541",
            "country_code": "US",
            "telephone_number": "919-235-6565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "231 N Judd Pkwy NE",
            "address_purpose": "LOCATION",
            "city": "Fuquay Varina",
            "state": "NC",
            "postal_code": "275262694",
            "country_code": "US",
            "telephone_number": "919-235-6410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECKER",
        "first_name": "KRISTOPHER",
        "middle_name": "WYATT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-30",
        "last_updated": "2023-03-07",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3643-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF IL",
            "identifier": "085-005532",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NC",
            "identifier": "0010-08659",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WI",
            "identifier": "3643-23",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdecker261613@directHISP.wakemed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "222 Ashville Ave Ste 10",
            "city": "Cary",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275186130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.