Online Wound Care Group PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ONLINE WOUND CARE GROUP PLLC

Practice address

101 Westpark Dr
Brentwood, TN 37027-5031

Phone

(910) 310-4551

NPI assigned

May 19, 2023

Organization subpart

No

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

Authorized official

Name

Stacey RaybuckNPI 1720020076

Title

President

Phone

(910) 310-4551

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, PA2 enrollments

Enrollment records 2

Locations

Practitioners 8

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

• Stephanie Brooke Duffer, NP

  • Nurse Practitioner
  • Gallatin, TN
  • NPI 1578706701
  Medicare reassignment Care Compare group NPD
• Kristina Michelle Favaloro, DNP

  • Nurse Practitioner
  • Bartlett, TN
  • NPI 1306294327
  Medicare reassignment Care Compare group NPD
• Alexandra Lukianoff, MD

  • Surgery Physician
  • Brentwood, TN
  • NPI 1427219583

  PA

  Medicare reassignment Care Compare group NPD
• Ashley Dawn Williams, FNP

  • Family Nurse Practitioner
  • Knoxville, TN
  • NPI 1386322774
  Medicare reassignment Care Compare group NPD
• Joseph Rudolph, MSN, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Camden, NJ
  • NPI 1285115451

  PA

  Medicare reassignment Care Compare group NPD
• Noelle James

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
  • NPI 1316523541
  Medicare reassignment NPD
• Elizabeth Diane Payne, APRN

  • Adult Health Nurse Practitioner
  • Louisville, KY
  • NPI 1700831138

  TN

  Medicare reassignment NPD
• Stacey Raybuck

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1720020076
  NPD Authorized official

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1487345369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WESTPARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275031",
            "telephone_number": "910-310-4551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WESTPARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275031",
            "telephone_number": "910-310-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONLINE WOUND CARE GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "RAYBUCK",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-310-4551"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorge Miguel Oliver, M.D.
• Elsie P Ollapally, M.D.
• Heather A Olson, L.C.S.W.
• Marysylvia Jennifer Omale Eddy
• One Love Counseling LLC
• Fadi Oraha
• Laurena Oraha
• Oral and Maxillofacial Surgery Affilates
• Oral Surgery Specialists of Brentwood
• Oraldna Labs Inc

• Family Medicine Physician in Brentwood, TN
• Providers in Brentwood, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.