Wake Specialty Physicians, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

WAKE SPECIALTY PHYSICIANS, LLC

Practice address

2406 Blue Ridge Rd
Suite 190
Raleigh, NC 27607-6678

Phone

(919) 789-4322

Fax

(919) 789-4533

NPI assigned

Jul 11, 2014

Organization subpart

No

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

Authorized official

Name

Maria Jayoussi

Title

Executive Director Finance

Phone

(919) 350-6089

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• WAKEMED URGENT CARE Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Wakemed

  • Home Health Agency
  • Raleigh, NC
  • NPI 1467435842

  Member Of

  NPD member

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1265848154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0552",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 BLUE RIDGE RD",
            "address_2": "SUITE 190",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076678",
            "telephone_number": "919-789-4322",
            "fax_number": "919-789-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR FINANCE",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013297365",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "7108950009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAKEMED URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC
• Wake Specialty Physicians, LLC

• Durable Medical Equipment & Medical Supplies in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.