NPIMap

Organization Active NPI

Southwest Durham Family Medicine, PLLC

Doing business as SW Durham Family Medicine

  • Family Medicine Physician
  • Durham, NC
National Provider Identifier
1295706133
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200300258 Issued in NC
Legal business name
SOUTHWEST DURHAM FAMILY MEDICINE, PLLC
Doing business as
SW Durham Family Medicine
Practice address
1515 W NC Hwy 54
Ste 130
Durham, NC 27707
Phone
(919) 419-0242
Fax
(919) 401-4172
NPI assigned
Jan 30, 2006
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Tiffany Marum, M.D.NPI 1548466204
Title
Managing Physician
Phone
(919) 419-0242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 200300258 NC Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 9700021 NC

Addresses

Primary practice location

1515 W NC Hwy 54
Ste 130
Durham, NC 27707

Mailing address

1515 W NC Hwy 54
Ste 130
Durham, NC 27707
Phone (919) 419-0242

Other identifiers 1

IdentifierTypeStateIssuer
017RTOtherNCBLUE CROSS BLUE SHIELD

Other names 1

  • SW Durham Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041213000018 NC Part B Supplier - Clinic/Group Practice 5294792248 Receives reassigned benefits from 3 practitioners
Practice locations: Durham, NC

National Provider Directory

National Provider Directory

Locations

245 E NC Highway 54
Ste 205
Durham, NC 27713
Phone (919) 419-0242

3612 Shannon Rd
Ste 105
Durham, NC 27707
Phone (919) 419-0242

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DFCAAA

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1295706133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 W NC HWY 54",
            "address_2": "STE 130",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27707",
            "telephone_number": "919-419-0242",
            "fax_number": "919-401-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W NC HWY 54",
            "address_2": "STE 130",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27707",
            "telephone_number": "919-419-0242",
            "fax_number": "919-401-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DURHAM FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "MARUM",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "919-419-0242",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200300258",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9700021",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "017RT",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SW Durham Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SW Durham Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.