Private Diagnostic Clinic, PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

PRIVATE DIAGNOSTIC CLINIC, PLLC

Doing business as

Carolina Family Practice & Sports Medicine-Raleigh

Practice address

8300 Health Park
Ste. 107
Raleigh, NC 27615-4730

Phone

(919) 238-2000

NPI assigned

Sep 19, 2012

Organization subpart

No

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

Authorized official

Name

Christopher Thomas Frederick

Title

Cfo

Phone

(919) 613-7762

Specialties & licenses 1

Addresses

Other names 1

• Carolina Family Practice & Sports Medicine-Raleigh Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1538410386",
    "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": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 HEALTH PARK",
            "address_2": "STE. 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154730",
            "telephone_number": "919-238-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-613-7762"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Family Practice & Sports Medicine-Raleigh",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carolina Family Practice & Sports Medicine-Raleigh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Medicine (Family Medicine) Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Sports Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.