NPIMap

Organization Active NPI

Wakemed Specialists Group, LLC

  • Durable Medical Equipment & Medical Supplies
  • Raleigh, NC
National Provider Identifier
1376108522
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WAKEMED SPECIALISTS GROUP, LLC
Practice address
8001 T W Alexander Dr Ste 224
Raleigh, NC 27617-4884
Phone
(919) 232-5020
Fax
(919) 232-5021
NPI assigned
May 3, 2019
Last updated
May 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2019

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

Authorized official

Name
Maria Jayoussi
Title
Executive Director of Finance
Phone
(919) 350-6089

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

8001 T W Alexander Dr Ste 224
Raleigh, NC 27617-4884

Mailing address

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

Other names 1

  • WakeMed Wake Orthopaedics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190829004199 NC DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2466788377 Practice locations: Raleigh, NC

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Wakemed

    dba WakeMed Mental Health & Well-Being Hospital WakeBrook

    • Psychiatric Hospital Unit
    • Raleigh, NC
    • NPI 1780446302

    Member Of

    NPD member

Locations

8001 T W Alexander Dr
Ste 224
Raleigh, NC 27617
Phone (919) 232-5050

NPI Registry JSON

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556841600000",
    "number": "1376108522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 HIGHWOODS BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276040010",
            "telephone_number": "919-350-0552",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 T W ALEXANDER DR STE 224",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276174884",
            "telephone_number": "919-232-5020",
            "fax_number": "919-232-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED SPECIALISTS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-03",
        "last_updated": "2019-05-03",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Wake Orthopaedics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.