NPIMap

Organization Active NPI

Wake Specialty Physicians LLC

Doing business as WakeMed Physician Practices Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Raleigh, NC
National Provider Identifier
1497204143
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
WAKE SPECIALTY PHYSICIANS LLC
Doing business as
WakeMed Physician Practices Group Home
Practice address
2820 Kidd Rd
Raleigh, NC 27610-1842
Phone
(919) 350-2800
Fax
(919) 350-8147
NPI assigned
Sep 22, 2016
Last updated
Mar 22, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WAKEMEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NC Primary
Family Medicine Physician 207Q00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

2820 Kidd Rd
Raleigh, NC 27610-1842

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0552

Other identifiers 1

IdentifierTypeStateIssuer
1942440375MedicaidNC

Other names 1

  • WakeMed Physician Practices Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Falls Pointe Medical Group73 organizations share this tax ID, including this one
Part of
Wake County Hosp Sys Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1497204143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "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": "2820 KIDD RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101842",
            "telephone_number": "919-350-2800",
            "fax_number": "919-350-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKEMED",
        "enumeration_date": "2016-09-22",
        "last_updated": "2017-03-22",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942440375",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Physician Practices Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 22, 2017; 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.