NPIMap

Organization Active NPI

Private Diagnostic Clinic, PLLC

  • Gastroenterology Physician
  • Raleigh, NC
National Provider Identifier
1366643124
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PRIVATE DIAGNOSTIC CLINIC, PLLC
Practice address
3480 Wake Forest Rd
Suite 500
Raleigh, NC 27609-7317
Phone
(919) 684-8111
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Christopher Thomas Frederick
Title
Cfo
Phone
(919) 613-7762

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X NC Primary

Addresses

Primary practice location

3480 Wake Forest Rd
Suite 500
Raleigh, NC 27609-7317

Mailing address

PO Box 110566
Durham, NC 27709-5566
Phone (919) 620-4855

Other identifiers 1

IdentifierTypeStateIssuer
230575OtherNCMEDICARE GROUP #

Other names 1

  • Duke Endoscopy of Raleigh Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cabarrus Memorial Hospi23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1366643124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110566",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095566",
            "telephone_number": "919-620-4855",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3480 WAKE FOREST RD",
            "address_2": "SUITE 500",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097317",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-613-7762"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "230575",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duke Endoscopy of Raleigh",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Duke Endoscopy of Raleigh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.