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Wakemed Specialists Group LLC

Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Raleigh, NC

NPI 1255995643 · NPPES record last updated Aug 13, 2019

Key facts

NPI
1255995643
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual Disabilities Intermediate Care Facility 315P00000X
Legal business name
WAKEMED SPECIALISTS GROUP LLC
Practice address
2820 Kidd Rd
Raleigh, NC 27610-1842
Phone
(919) 350-2800
Fax
(919) 350-8147
NPI assigned
May 1, 2019
Organization subpart
No

Authorized official

Name
Maria Jayoussi
Title
Executive Director of Finance
Phone
(919) 350-6089

Other NPIs on the same Medicare enrollment 47

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

View all 47

Corporate family (same tax ID) 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190731000815 NC Part B Supplier - Clinic/Group Practice 2466788377 Receives reassigned benefits from 1,327 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Wakemed Specialists Group LLC (36 organizations share this tax ID)

Locations

8001 T W Alexander Dr
Raleigh, NC 27617
Phone (919) 350-0953

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X
Intellectual Disabilities Intermediate Care Facility 315P00000X Yes

Addresses

Primary practice location

2820 Kidd Rd
Raleigh, NC 27610-1842

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0552

Other identifiers

IdentifierTypeStateIssuer
1255995643MedicaidNC

Other names

  • WakeMed Hospitalist Group Home Doing business as

Other providers in Raleigh, NC

All providers in Raleigh, NC · Intellectual Disabilities Intermediate Care Facility in North Carolina

Sources for this page

Verify at the official NPI Registry.