Carl Diedritch Sickerott Jr.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

MHL-092-469 Issued in NC

Practice address

2026 Fairview Rd
Raleigh, NC 27608-2316

Phone

(919) 946-1758

NPI assigned

Aug 14, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• The Bray Home

  • Adult Care Home Facility
  • Raleigh, NC
  • NPI 1164773503
  NPD (past) Authorized official
• The Bray Home

  • Adult Care Home Facility
  • Raleigh, NC
  • NPI 1871843904
  NPD (past) Authorized official

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

{
    "created_epoch": "1344902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345766400000",
    "number": "1518214022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2026 FAIRVIEW RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082316",
            "telephone_number": "919-946-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2026 FAIRVIEW RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082316",
            "telephone_number": "919-946-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SICKEROTT",
        "first_name": "CARL",
        "middle_name": "DIEDRITCH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-14",
        "last_updated": "2012-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-092-469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804353",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Sibert
• Emily Christine Sibley, DC, MS, BS
• Gerald Bruce Sibrack, MD
• Amanda Sibrizzi, LCMHC-A, NCC
• Lawrence Mark Sichel, MD
• Adeel Mohammad Siddiqui, M.D.
• Arshiya F Siddiqui, LCSWA
• Isra Siddiqui
• Nouman Siddiqui, M.D.
• Ashley Siddle

• Adult Care Home Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2012; 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.