NPIMap

Individual provider Active NPI

Thomas Elliott Pendergrast, M.D.

  • Diagnostic Radiology Physician
  • Raleigh, NC
National Provider Identifier
1548680366
Registry record updated Apr 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2020-00123 Issued in NC
Practice address
3200 Blue Ridge Rd Ste 100
Raleigh, NC 27612-8087
Phone
(919) 256-3576
NPI assigned
Apr 19, 2014
Sex
Male
Sole proprietor
No

Organizations & group practices 6

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wake Forest University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raleigh Radiology Wakemed Imaging, LLC 57 clinicians
Centra Medical Group LLC 709 clinicians
Raleigh Radiology Associates Inc 58 clinicians
Raleigh Radiology LLC 61 clinicians

Practice addresses (Care Compare)

11640 Northpark Dr
Suite 110
Wake Forest, NC 27587-5741
Phone (919) 781-1437

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

2108 Dunhill Dr
Raleigh, NC 27608-1536
Phone (434) 200-5047

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7000

3200 Blue Ridge Rd
Suite 100
Raleigh, NC 27612-8087
Phone (919) 781-1437

Hospital & facility affiliations

  • Centra Health - Lynchburg Gen Hospital Hospital, Lynchburg, VA, CCN 490021
  • Southside Community Hospital, Inc Hospital, Farmville, VA, CCN 490090
  • Centra Bedford Memorial Hospital Hospital, Bedford, VA, CCN 490088
  • Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069
  • Wilson Medical Center Hospital, Wilson, NC, CCN 340126

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Merit-based Incentive Payment System (MIPS)

Final score
93.55 of 100Reported as group
Quality
100
Improvement activities
40
Cost
78.49

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC, VA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200507002791 NC Practitioner - Diagnostic Radiology 7315255247 Reassigns benefits to 4 organizations
I20210329000598 SC Practitioner - Diagnostic Radiology 7315255247 Reassigns benefits to 1 organization
I20210329000693 VA Practitioner - Diagnostic Radiology 7315255247 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Medical Group, LLC CurrentSince Jun 15, 2023 Accepting new patients
Raleigh Radiology, LLC Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients
Raleigh Radiology Associates, Inc. Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients
Raleigh Radiology Wakemed Imaging, LLC Diagnostic Radiology CurrentSince Feb 19, 2021 Accepting new patients

Locations

150 Parkway Office Ct
Ste 100
Cary, NC 27518

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

11618 Clayton Blvd
Ste 102
Clayton, NC 27520

3200 Blue Ridge Rd
Ste 100
Raleigh, NC 27612
Phone (919) 256-3576

5220 Greens Dairy Rd
Raleigh, NC 27616
Phone (540) 493-4581

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

11640 Northpark Dr
Ste 110
Wake Forest, NC 27587

2000 Hospital Dr
Mt Pleasant, SC 29464
Phone (803) 533-2200

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

600 W Ridge Rd
Wytheville, VA 24382
Phone (276) 228-0200

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101271086 VA
Diagnostic Radiology Physician 2085R0202X 2020-00123 NC Primary

Addresses

NPPES NPI Registry

Primary practice location

3200 Blue Ridge Rd Ste 100
Raleigh, NC 27612-8087

Mailing address

5220 Greens Dairy Rd
Raleigh, NC 27616-4612

Other practice location 1

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 200-5047

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 30, 2023.

{
    "created_epoch": "1397865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682812800000",
    "number": "1548680366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 GREENS DAIRY RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276164612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128087",
            "telephone_number": "919-256-3576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Tate Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Lynchburg",
            "state": "VA",
            "postal_code": "245011109",
            "country_code": "US",
            "telephone_number": "434-200-5047",
            "fax_number": "434-200-6490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDERGRAST",
        "first_name": "THOMAS",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-19",
        "last_updated": "2023-04-30",
        "certification_date": "2023-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101271086",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2020-00123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.