Individual provider Active NPI

Joseph Walter Bruckert, M.D.

  • Family Medicine Physician
  • Cary, NC
National Provider Identifier
1306993019
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39359 Issued in NC
Practice address
115 Crescentcommons Dr Ste 100
Cary, NC 27518-8102
Phone
(919) 803-3707
Fax
(919) 803-1969
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39359 NC Primary

Addresses

Primary practice location

115 Crescentcommons Dr Ste 100
Cary, NC 27518-8102

Mailing address

4705 University Dr BLDG 700
Durham, NC 27707-3489
Phone (919) 237-1337

Other practice location 1

1110 S.E. Cary Parkway
Ste 203
Cary, NC 27518-7420
Phone (919) 851-7867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100730000146 NC Practitioner - Family Practice 5092806265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

115 Crescentcommons Dr
Suite 100
Cary, NC 27518-8102
Phone (919) 655-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39359NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crescent Family Practice, P.a. Current Accepting new patients
Avance Care, PA CurrentSince Dec 1, 2023 Accepting new patients

Locations

115 Crescentcommons Dr
Ste 100
Cary, NC 27518
Phone (919) 467-5678

100 Ridge View Dr
Ste 105
Cary, NC 27511
Phone (919) 851-7867

4705 University Dr
Bldg 700
Durham, NC 27707
Phone (919) 237-1337

7510 Ramble Way
Ste 107
Raleigh, NC 27616
Phone (919) 277-8880

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1306993019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 UNIVERSITY DR BLDG 700",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073489",
            "telephone_number": "919-237-1337",
            "fax_number": "919-237-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CRESCENTCOMMONS DR STE 100",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188102",
            "telephone_number": "919-803-3707",
            "fax_number": "919-803-1969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 S.E. Cary Parkway",
            "address_2": "Ste 203",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275187420",
            "country_code": "US",
            "telephone_number": "919-851-7867",
            "fax_number": "919-851-7866",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKERT",
        "first_name": "JOSEPH",
        "middle_name": "WALTER",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "39359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.