NPIMap

Wakemed Specialists Group LLC

Organization Active NPI Internal Medicine Physician · Cary, NC

NPI 1326786138 · NPPES record last updated May 23, 2022

Key facts

NPI
1326786138
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
WAKEMED SPECIALISTS GROUP LLC
Practice address
210 Ashville Ave
Cary, NC 27518-6600
Phone
(919) 350-4515
Fax
(919) 230-1308
NPI assigned
May 23, 2022
Organization subpart
No

Authorized official

Name
Shondra Lynn Brink
Title
VP, WPP
Phone
(919) 350-6045

Other NPIs on the same Medicare enrollment 47

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

View all 47

Corporate family (same tax ID) 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners 4

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2223716Wakemed Wound Care Center of Cary
210 Ashville Avenue, Suite 420, Cary, NC 27518		Certificate of waiverMay 9, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190731000815 NC Part B Supplier - Clinic/Group Practice 2466788377 Receives reassigned benefits from 1,327 practitioners
47 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Wakemed Specialists Group LLC (36 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes

Addresses

Primary practice location

210 Ashville Ave
Cary, NC 27518-6600

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0554

Other names

  • WakeMed Wound Care Center Doing business as

Other providers in Cary, NC

All providers in Cary, NC · Internal Medicine Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.