NPIMap

Organization Active NPI

Raleigh Durham Medical Group PA

Doing business as Knightdale Family Practice

  • Family Medicine Physician
  • Knightdale, NC
National Provider Identifier
1306899125
Registry record updated Aug 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RALEIGH DURHAM MEDICAL GROUP PA
Doing business as
Knightdale Family Practice
Practice address
7124 Knightdale Blvd
Knightdale, NC 27545-9265
Phone
(919) 266-6211
Fax
(919) 854-7774
NPI assigned
May 19, 2006
Last updated
Aug 31, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
RALEIGH DURHAM MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2009

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

Authorized official

Name
David K Moye
Title
Senior Vice President
Phone
(919) 851-2174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

7124 Knightdale Blvd
Knightdale, NC 27545-9265

Mailing address

5420 Wade Park Blvd
Ste 106
Raleigh, NC 27607-4188
Phone (919) 851-2174

Other names 1

  • Knightdale Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000155 NC Part B Supplier - Clinic/Group Practice 2365409588 Receives reassigned benefits from 103 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Four Oaks, NC; Greenville, NC; Morrisville, NC; Raleigh, NC; Wake Forest, NC; Cary, NC; Fayetteville, NC…

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Raleigh Durham Medical

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1306899125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 WADE PARK BLVD",
            "address_2": "STE 106",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276074188",
            "telephone_number": "919-851-2174",
            "fax_number": "919-854-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7124 KNIGHTDALE BLVD",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459265",
            "telephone_number": "919-266-6211",
            "fax_number": "919-854-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "MOYE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "919-851-2174"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Knightdale Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knightdale, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.