NPIMap

Organization Active NPI

Wakemed Specialists Group LLC

  • Orthopaedic Surgery Physician
  • Raleigh, NC
National Provider Identifier
1417512690
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
WAKEMED SPECIALISTS GROUP LLC
Practice address
3009 New Bern Ave
Raleigh, NC 27610-1214
Phone
(919) 232-5020
Fax
(919) 232-5021
NPI assigned
May 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

3009 New Bern Ave
Raleigh, NC 27610-1214

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0552

Other identifiers 1

IdentifierTypeStateIssuer
1417512690MedicaidNC

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
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

Other NPIs on the same Medicare enrollment 47

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

View all 47

National Provider Directory

National Provider Directory

Locations

101 Holly Creek Rd
Morrisville, NC 27560
Phone (919) 235-6480

505 Oberlin Rd
Ste 120
Raleigh, NC 27605

Practitioners & affiliated clinicians

Practitioners 51

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

View all 51

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": "1566432000000",
    "number": "1417512690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "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": "3009 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101214",
            "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": "2019-08-22",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417512690",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Wake Orthopaedics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "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 Aug 22, 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.