Med One Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MED ONE MEDICAL GROUP

Practice address

7019-200 Harps Mill Rd.
Raleigh, NC 27615

Phone

(919) 850-1300

Fax

(919) 850-0012

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Tiffany L. Conner

Title

Insurance and Billing Manager

Phone

(919) 850-1300

Specialties & licenses 5

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Tax ID family

Med One Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Med One

  • Primary Care Clinic/Center
  • Raleigh, NC
  • NPI 1093146177
  NPD tax ID
• Med One Medical Group

  • Non-Pharmacy Dispensing Site
  • Raleigh, NC
  • NPI 1841600749
  NPD tax ID

Locations

Practitioners 6

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

• Gary Gruber, D.C.

  • Chiropractor
  • Raleigh, NC
  • NPI 1558305060
  Medicare reassignment NPD
• Katherine Barragan

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1497525810
  NPD (past)
• Cara L. Davis, M.D.

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1952338782
  NPD (past)
• Crystal Larson

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1932095387
  NPD (past)
• Joanne Louise Pizzino, MD, MPH

  • Occupational Medicine Physician
  • Cary, NC
  • NPI 1245216365
  NPD (past)
• Jennifer Lynn Simpson, FNP

  • Family Nurse Practitioner
  • Raleigh, NC
  • NPI 1457628075
  NPD (past)

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1548346331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7019-200 HARPS MILL RD.",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27615",
            "telephone_number": "919-850-1300",
            "fax_number": "919-850-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7019-200 HARPS MILL RD.",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27615",
            "telephone_number": "919-850-1300",
            "fax_number": "919-850-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED ONE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-03-07",
        "certification_date": "2019-12-20",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "INSURANCE AND BILLING MANAGER",
        "authorized_official_telephone_number": "919-850-1300",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2394",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "930076",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "0050-02018",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "201835",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # - KERNEY YU",
            "identifier": "5011967",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # - TYLER CASSIDY",
            "identifier": "0010-04356",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARA L. DAVIS LICENSE",
            "identifier": "930076",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "G. GRUBER DC LICENSE #",
            "identifier": "2394",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "J. CHARLES ANP LISCENSE",
            "identifier": "0050-02018",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Med First Immediate Care & Family Practice, PA
• Med First Immediate Care & Family Practice, PA
• Med First Immediate Care & Family Practice, PA
• Med First Urgent Care, PLLC
• Med One
• Med One Medical Group
• Med-Caire Inc.
• Med-X Consulting, PC
• Medassist, Inc.
• Russell Glen Medders, MD

• Internal Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.