NPIMap

Organization Active NPI

Wakemed Specialists Group LLC

Doing business as WakeMed Wound Care Center

  • Internal Medicine Physician
  • Cary, NC
National Provider Identifier
1326786138
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WAKEMED SPECIALISTS GROUP LLC
Doing business as
WakeMed Wound Care Center
Practice address
210 Ashville Ave
Cary, NC 27518-6600
Phone
(919) 350-4515
Fax
(919) 230-1308
NPI assigned
May 23, 2022
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

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 1

  • WakeMed Wound Care Center Doing business as

Medicare participation

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

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 47

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

View all 47

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2223716Wakemed Wound Care Center of Cary210 Ashville Avenue, Suite 420, Cary, NC 27518Certificate of waiverMay 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Wakemed Specialists Group L36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Practitioners & affiliated clinicians

Practitioners 4

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": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1326786138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ASHVILLE AVE",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186600",
            "telephone_number": "919-350-4515",
            "fax_number": "919-230-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED SPECIALISTS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "BRINK",
        "authorized_official_first_name": "SHONDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP, WPP",
        "authorized_official_telephone_number": "919-350-6045"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Wound Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.