NPIMap

Organization Active NPI

Cedar Oaks Clinic PLLC

  • Psychiatry Physician
  • Wake Forest, NC
National Provider Identifier
1184209470
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CEDAR OAKS CLINIC PLLC
Practice address
1748 Heritage Center Dr Ste 101
Wake Forest, NC 27587-9855
Phone
(919) 332-8969
NPI assigned
Mar 17, 2021
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Cedar Oaks Clinic
Title
Clinic
Phone
(919) 529-5920

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1748 Heritage Center Dr Ste 101
Wake Forest, NC 27587-9855

Mailing address

1748 Heritage Center Dr Ste 101
Wake Forest, NC 27587-9855

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210413001294 NC Part B Supplier - Clinic/Group Practice 0547678500 Receives reassigned benefits from 10 practitioners
Practice locations: Wake Forest, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2284535Cedar Oaks Clinic1748 Heritage Center Dr, Suite 101, Wake Forest, NC 27587Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory

Locations

1748 Heritage Center Dr
Ste 101
Wake Forest, NC 27587
Phone (919) 529-5920

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1184209470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1748 HERITAGE CENTER DR STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275879855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1748 HERITAGE CENTER DR STE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275879855",
            "telephone_number": "919-332-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR OAKS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "CLINIC",
        "authorized_official_first_name": "CEDAR OAKS",
        "authorized_official_title_or_position": "CLINIC",
        "authorized_official_telephone_number": "919-529-5920"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.