Wakemed

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WAKEMED

Doing business as

WakeMed Professional Physicians Staff

Practice address

3000 New Bern Ave
Raleigh, NC 27610-1231

Phone

(919) 350-8000

Fax

(919) 350-0559

NPI assigned

Dec 5, 2007

Last updated

Jan 23, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Rebecca E. Andrews

Title

VP, Finance

Phone

(919) 350-8344

Specialties & licenses 15

Addresses

Other identifiers 2

Other names 1

• WakeMed Professional Physicians Staff Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wakemed

  dba Wakemed Cary Hospital

  • General Acute Care Hospital
  • Cary, NC
  • NPI 1114993086

  7315937612

  Same PAC ID
• Wakemed

  dba WakeMed Home Health

  • Home Health Agency
  • Raleigh, NC
  • NPI 1467435842

  7315937612

  Same PAC ID
• Wakemed

  dba WakeMed Mental Health & Well-Being Hospital WakeBrook

  • Psychiatric Hospital Unit
  • Raleigh, NC
  • NPI 1780446302

  7315937612

  Same PAC ID
• Wakemed

  dba WakeMed Raleigh Campus Rehabilitation Unit

  • Rehabilitation Hospital Unit
  • Raleigh, NC
  • NPI 1790752236

  7315937612

  Same PAC ID
• Wakemed

  dba WakeMed Raleigh Campus

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1972579837

  7315937612

  Same PAC ID

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Wake County Rehabilitation Hospital LLC

  dba Peak Rehabilitation Hospital

  • Rehabilitation Hospital
  • Apex, NC
  • NPI 1952144511

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 193

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.

• Bradley Mark Avery, PHD

  • Clinical Neuropsychologist
  • Raleigh, NC
  • NPI 1063948727
  Medicare reassignment Care Compare group NPD
• Brittany Marie Ballard, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1912723537
  Medicare reassignment Care Compare group NPD
• Jeremiah Fuller Bell, M.D.

  • Neurocritical Care Physician
  • Greenville, NC
  • NPI 1639533870
  Medicare reassignment Care Compare group NPD
• Taylor Ann Britt, LCSWA

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1093485161
  Medicare reassignment Care Compare group NPD
• Courtney Brown

  • Clinical Neuropsychologist
  • Raleigh, NC
  • NPI 1447635396
  Medicare reassignment Care Compare group NPD
• Katelyn Denise Brown, PHD

  • Clinical Neuropsychologist
  • Cary, NC
  • NPI 1376212159
  Medicare reassignment Care Compare group NPD
• Kierra Nechelle Bryant, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1336010313
  Medicare reassignment Care Compare group NPD
• Kirsten Loren Bubak, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1053174508
  Medicare reassignment Care Compare group NPD
• Maria K Butler, PSY.D.

  • Clinical Neuropsychologist
  • Raleigh, NC
  • NPI 1275052565
  Medicare reassignment Care Compare group NPD
• Tyisha Chanel Cardwell, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1790447142
  Medicare reassignment Care Compare group NPD
• Siddharth Dalal, MD

  • Neurology Physician
  • Charlotte, NC
  • NPI 1811488455

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Kimberly Jones Dekan, LCSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1902238108
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1194907717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "address_2": "MANAGED CARE CONTRACTING DEPT.",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-0558",
            "fax_number": "919-350-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-8000",
            "fax_number": "919-350-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "VP, FINANCE",
        "authorized_official_telephone_number": "919-350-8344",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890770G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194907717",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Professional Physicians Staff",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Urological Associates, P.a.
• Wakefield Chiropractic, PLLC
• Wakefield Pediatrics & Adolescent Medicine,P.a.
• Wakehealth Medical Group, PA.
• Wakemed (WakeMed Health and Hospitals)
• Wakemed (WakeMed Mental Health & Well-Being Hospital WakeBrook)
• Wakemed
• Wakemed (WakeMed Home Health)
• Wakemed
• Wakemed (WakeMed Mental Health & Well-Being Hospital WakeBrook)

• Internal Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.