Individual provider Active NPI

Foram Patel, PA

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1386364636
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.009122 Issued in IL
Practice address
7850 Brier Creek Pkwy # 100
Raleigh, NC 27617-8900
Phone
(919) 748-4878
NPI assigned
Aug 29, 2022
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.009122 ID
Physician Assistant 363A00000X 085.009122 IL Primary

Addresses

Primary practice location

7850 Brier Creek Pkwy # 100
Raleigh, NC 27617-8900

Mailing address

4705 University Dr BLDG 700
Durham, NC 27707-3489
Phone (919) 237-1337

Other practice location 1

4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone (773) 388-1800

Other identifiers 1

IdentifierTypeStateIssuer
085.009122MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220912000853 IL Practitioner - Physician Assistant 6800271982 Reassigns benefits to 1 organization
I20240403002947 NC Practitioner - Physician Assistant 6800271982 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

7510 Ramble Way
Suite 107
Raleigh, NC 27616-4305
Phone (919) 747-3033

7850 Brier Creek Pkwy
Raleigh, NC 27617-8900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.009122IDMDPhysician Assistant
085.009122ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Brown Health Center CurrentSince Aug 1, 2022 Accepting new patients
Howard Brown Health Center CurrentSince Aug 1, 2022 Accepting new patients
Howard Brown Health Center Past Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

1025 W Sunnyside Ave
Ste 100
Chicago, IL 60640

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1386364636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 UNIVERSITY DR BLDG 700",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073489",
            "telephone_number": "919-237-1337",
            "fax_number": "919-237-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7850 BRIER CREEK PKWY # 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276178900",
            "telephone_number": "919-748-4878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4025 N Sheridan Rd",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606132010",
            "country_code": "US",
            "telephone_number": "773-388-1800",
            "fax_number": "773-388-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "FORAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-29",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "085.009122",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.009122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085.009122",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.