Organization Active NPI

Ibis Health Services - North Carolina, PLLC

  • Internal Medicine Physician
  • Raleigh, NC
National Provider Identifier
1265216873
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
IBIS HEALTH SERVICES - NORTH CAROLINA, PLLC
Practice address
176 Mine Lake CT Ste 100
Raleigh, NC 27615-6417
Phone
(908) 230-4612
Fax
(207) 401-2727
NPI assigned
Aug 23, 2023
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Piali De, PHD
Title
Ceo of Mso (Senscio Systems)
Phone
(617) 834-2853

Practitioners 5

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240228002993 NC Part B Supplier - Clinic/Group Practice 0446695530 Receives reassigned benefits from 5 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

176 Mine Lake Ct
#100
Raleigh, NC 27615
Phone (404) 428-7041

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

176 Mine Lake CT Ste 100
Raleigh, NC 27615-6417

Mailing address

215 Ayer Rd Unit 797
Harvard, MA 01451-5033
Phone (978) 635-9090

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 23, 2023.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1265216873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 AYER RD UNIT 797",
            "city": "HARVARD",
            "state": "MA",
            "postal_code": "014515033",
            "telephone_number": "978-635-9090",
            "fax_number": "207-401-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 MINE LAKE CT STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276156417",
            "telephone_number": "908-230-4612",
            "fax_number": "207-401-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBIS HEALTH SERVICES - NORTH CAROLINA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "DE",
        "authorized_official_first_name": "PIALI",
        "authorized_official_title_or_position": "CEO OF MSO (SENSCIO SYSTEMS)",
        "authorized_official_telephone_number": "617-834-2853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.