NPIMap

Wakemed Specialists Group, LLC

Organization Active NPI Gastroenterology Physician · Raleigh, NC

NPI 1356906705 · NPPES record last updated Jul 23, 2025

Key facts

NPI
1356906705
Entity type
Organization (NPI type 2)
Primary specialty
Gastroenterology Physician 207RG0100X
Legal business name
WAKEMED SPECIALISTS GROUP, LLC
Practice address
3024 New Bern Ave
Raleigh, NC 27610-1247
Phone
(919) 350-5318
Fax
(919) 350-7093
NPI assigned
May 1, 2019
Organization subpart
No

Authorized official

Name
Karen Revicki Perry
Title
Sled
Phone
(919) 350-8000

Other NPIs on the same Medicare enrollment 47

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

View all 47

Practitioners 49

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

View all 49

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RG0100X Yes

Addresses

Primary practice location

3024 New Bern Ave
Raleigh, NC 27610-1247

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010
Phone (919) 350-0552

Other names

  • WakeMed Gastroenterology Other name

Other providers in Raleigh, NC

All providers in Raleigh, NC · Gastroenterology Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.