NPIMap

Organization Active NPI

Wake Emergency Physicians PA

  • Emergency Medicine Physician
  • Smithfield, NC
National Provider Identifier
1174086441
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WAKE EMERGENCY PHYSICIANS PA
Practice address
509 N Brightleaf Blvd
Smithfield, NC 27577-4407
Phone
(919) 934-8171
Fax
(919) 336-4363
NPI assigned
Apr 12, 2019
Last updated
Apr 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Authorized official

Name
Dr. Jennifer Raley, MD
Title
Managing Partner
Phone
(919) 859-3373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

509 N Brightleaf Blvd
Smithfield, NC 27577-4407

Mailing address

PO Box 890053
Charlotte, NC 28289-0053
Phone (855) 691-9890

Other identifiers 3

IdentifierTypeStateIssuer
2319661AOtherMEDICARE
CD5224OtherNCRAILROAD MEDICARE
0295FOtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000295 NC Part B Supplier - Clinic/Group Practice 9931002078 Receives reassigned benefits from 296 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rocky Mount, NC; Wendell, NC; Smithfield, NC; Raleigh, NC; Kinston, NC; Goldsboro, NC; Garner, NC; Clayton, NC…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1174086441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890053",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890053",
            "telephone_number": "855-691-9890",
            "fax_number": "919-350-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N BRIGHTLEAF BLVD",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275774407",
            "telephone_number": "919-934-8171",
            "fax_number": "919-336-4363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE EMERGENCY PHYSICIANS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-12",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "RALEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "919-859-3373",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2319661A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD5224",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0295F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.