Individual provider Active NPI

Ian Flyke, MD

  • Obstetrics & Gynecology Physician
  • Raleigh, NC
National Provider Identifier
1417577339
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
261399 Issued in NC
Practice address
4414 Lake Boone TRL Ste 405
Raleigh, NC 27607-7520
Phone
(919) 876-8225
NPI assigned
Apr 21, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 261399 NC
Obstetrics & Gynecology Physician 207V00000X 261399 NC Primary

Addresses

Primary practice location

4414 Lake Boone TRL Ste 405
Raleigh, NC 27607-7520

Mailing address

4224 Vallonia Dr
Cary, NC 27519-6704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241020000016 NC Practitioner - Obstetrics/Gynecology 8426488743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Wisconsin School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uwh of the Carolinas PLLCGroup PAC ID 0042448169, 329 clinicians

Practice addresses (Care Compare)

4414 Lake Boone TRL
Suite 405
Raleigh, NC 27607-7520
Phone (919) 876-8225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
261399NCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Uwh of the Carolinas, PLLC Obstetrics & Gynecology CurrentSince Sep 1, 2024 Accepting new patients
Raleigh OB/GYN Centre, PA Past Accepting new patients
Whap, PA Obstetrics & Gynecology Past Accepting new patients

Locations

11009 Ingleside Pl
Ste 301
Raleigh, NC 27614
Phone (919) 876-8225

4414 Lake Boone Trl
Ste 405
Raleigh, NC 27607
Phone (919) 876-8225

1806 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 768-3632

Interoperability endpoints

  • Direct secure messaging: ian.flyke.1@7773.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/7773/brand/51/csg/541/fhir/r4
  • Direct secure messaging: iflyke312096@directhisp.wakemed.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1417577339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4224 VALLONIA DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275196704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL STE 405",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077520",
            "telephone_number": "919-876-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYKE",
        "first_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-21",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "261399",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "261399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.