Active NPI
Jeffrey Jay Tanaka, M.D.
- Pediatrics Physician
- Raleigh, NC
National Provider Identifier
1548270358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 39114
- Practice address
- 2605 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6475 - Phone
- (919) 881-9009
- Fax
- (919) 881-8463
- NPI assigned
- Aug 8, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 39114 | NC | Primary |
Addresses
Primary practice location
2605 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6475
Mailing address
2605 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6475
Phone (919) 881-9009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39114 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Kids Pediatric Associates | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548270358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2605 BLUE RIDGE RD",
"address_2": "SUITE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076475",
"telephone_number": "919-881-9009",
"fax_number": "919-881-8463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 BLUE RIDGE RD",
"address_2": "SUITE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076475",
"telephone_number": "919-881-9009",
"fax_number": "919-881-8463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANAKA",
"first_name": "JEFFREY",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "39114",
"primary": true
}
],
"identifiers": [],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.