NPIMap

Organization Active NPI

Wake Dermatology Associates, PA

  • Dermatology Physician
  • Raleigh, NC
National Provider Identifier
1497815328
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
40537 Issued in NC
Legal business name
WAKE DERMATOLOGY ASSOCIATES, PA
Practice address
4414 Lake Boone TRL
Ste 408
Raleigh, NC 27607-7513
Phone
(919) 781-1001
Fax
(919) 781-3909
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Authorized official

Name
Dr. Adnan Nasir, M.D.NPI 1457429706
Title
Physician, Owner
Phone
(919) 781-1001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 40537 NC Primary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X 40537 NC

Addresses

Primary practice location

4414 Lake Boone TRL
Ste 408
Raleigh, NC 27607-7513

Mailing address

4414 Lake Boone TRL
Ste 408
Raleigh, NC 27607-7513
Phone (919) 781-1001

Other identifiers 2

IdentifierTypeStateIssuer
2344640OtherMEDICARE GROUP NUMBER
02261OtherNCBLUE CROSS GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040915000991 NC Part B Supplier - Clinic/Group Practice 9931176237 Receives reassigned benefits from 2 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

2800 Blue Ridge Rd
Ste 302
Raleigh, NC 27607
Phone (919) 781-1001

4414 Lake Boone Trl
Ste 408
Raleigh, NC 27607
Phone (919) 781-1001

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9561/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1497815328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "STE 408",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-781-1001",
            "fax_number": "919-781-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "STE 408",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-781-1001",
            "fax_number": "919-781-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE DERMATOLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "NASIR",
        "authorized_official_first_name": "ADNAN",
        "authorized_official_title_or_position": "PHYSICIAN, OWNER",
        "authorized_official_telephone_number": "919-781-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": "40537",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NC",
            "license": "40537",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "2344640",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "02261",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 4, 2011; 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.