Individual provider Active NPI

Victor Marcel Gellineau III, M.D.

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1184794331
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2021-02186 Issued in NC
Practice address
4600 Capital Blvd
Raleigh, NC 27604-4478
Phone
(919) 980-7008
Fax
(919) 336-4528
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2021-02186 NC Primary
Family Medicine Physician 207Q00000X A75952 CA

Addresses

Primary practice location

4600 Capital Blvd
Raleigh, NC 27604-4478

Mailing address

PO Box 746724
Atlanta, GA 30374-6724
Phone (312) 733-9730

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090709000551 CA Practitioner - Family Practice 3072665751
I20210909001444 NC Practitioner - Family Practice 3072665751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.11 of 100Reported as group
Quality
86.24
Promoting interoperability
100
Improvement activities
40
Cost
78.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A75952CAMDFamily Medicine Physician
2021-02186NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osh-Mi Physicians Group PC Family Medicine CurrentSince Jun 24, 2021 Accepting new patients
Osh Mi Physicians Group, PC CurrentSince Jun 24, 2021 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

3250 Freedom Dr
Charlotte, NC 28208
Phone (704) 394-0118

4600 Capital Blvd
Raleigh, NC 27604
Phone (919) 336-4528

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1184794331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746724",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746724",
            "telephone_number": "312-733-9730",
            "fax_number": "773-866-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 CAPITAL BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276044478",
            "telephone_number": "919-980-7008",
            "fax_number": "919-336-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELLINEAU",
        "first_name": "VICTOR",
        "middle_name": "MARCEL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2021-02186",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A75952",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.