NPIMap

Organization Active NPI

Private Diagnositc Clinic

  • Primary Care Clinic/Center
  • Raleigh, NC
National Provider Identifier
1477099471
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
561029437 Issued in NC
Legal business name
PRIVATE DIAGNOSITC CLINIC
Practice address
10211 Alm St
Suite 200
Raleigh, NC 27617-8221
Phone
(919) 307-0301
Fax
(919) 307-0323
NPI assigned
Jan 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
James Scott Gibson
Title
Executive Vice Dean Administration
Phone
(919) 684-3945

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 561029437 NC Primary

Addresses

Primary practice location

10211 Alm St
Suite 200
Raleigh, NC 27617-8221

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1447306113MedicaidNC

Other names 1

  • DUKE CHILDREN'S PRIMARY CARE Other name

National Provider Directory

National Provider Directory
Tax ID family
Duke University Dba24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1477099471",
    "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": "919-307-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10211 ALM ST",
            "address_2": "SUITE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276178221",
            "telephone_number": "919-307-0301",
            "fax_number": "919-307-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSITC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "EXECUTIVE VICE DEAN ADMINISTRATION",
        "authorized_official_telephone_number": "919-684-3945"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "561029437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447306113",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DUKE CHILDREN'S PRIMARY CARE",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "DUKE CHILDREN'S PRIMARY CARE",
            "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 Sep 12, 2023; 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.