Wake Specialty Physicians LLC
Organization Active NPI Family Medicine Physician · Garner, NC
NPI 1346501673 · NPPES record last updated Oct 30, 2017
Key facts
- NPI
- 1346501673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- WAKE SPECIALTY PHYSICIANS LLC
- Practice address
- 400 US Highway 70 East
Garner, NC 27529-4049 - Phone
- (919) 235-6400
- Fax
- (919) 350-9835
- NPI assigned
- Jun 4, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- WAKE SPECIALTY PHYSICIANS LLC
Authorized official
- Name
- Maria Jayoussi
- Title
- Executive Director of Finance
- Phone
- (919) 350-6089
Other NPIs on the same Medicare enrollment 43
Practitioners 12
-
Aleksandra Avery, MD
-
Courtney Leigh Kozischek, MS, RD, LDN
-
George Daniel Kryder, M.D.
-
Elizabeth Lee Mizelle, D.O.
-
Juliette Dewitt Parks, PA-C
-
Anjali Solanki, D.O.
-
Samantha Liane Elmore, PA-C
-
Anita Makowski, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2045114 | Wakemed Primary Care - | Provider-performed microscopy | Aug 6, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090601000520 | NC | Part B Supplier - Clinic/Group Practice | 7416006085 |
Receives reassigned benefits from 283 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Falls Pointe Medical Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X |
Addresses
Primary practice location
400 US Highway 70 East
Garner, NC 27529-4049
Mailing address
PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0552
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346501673 | Medicaid | NC |
Other names
- WakeMed Primary Care Garner
Other providers in Garner, NC
- Olivia Faye Vogel
- Volta Group International
- Gia Vu
- Wake Emergency Physicians PA
- Wake Specialty Physicians LLC
- Wake Specialty Physicians LLC
- Wake Spine and Pain Specialists, PC
- Wake Urgent Care & Family Clinic Inc.
- Wakemed Specialists Group, LLC
- Wakemed Specialists Group, LLC
All providers in Garner, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.