NPIMap

Individual provider Active NPI

Caleb Tyler Runyon, PA-C

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1548976962
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-13473 Issued in NC
Practice address
3200 Blue Ridge Rd
Raleigh, NC 27612-8086
Phone
(919) 781-1437
Fax
(919) 787-4870
NPI assigned
Jan 30, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 0010-13473 NC Primary

Addresses

Primary practice location

3200 Blue Ridge Rd
Raleigh, NC 27612-8086

Mailing address

2831 Piedmont River Way
Raleigh, NC 27606-7403
Phone (859) 324-0138

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230921001281 NC Practitioner - Physician Assistant 0840644027 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raleigh Radiology Associates IncGroup PAC ID 6800874611, 58 clinicians
Raleigh Radiology Wakemed Imaging, LLCGroup PAC ID 8325453459, 57 clinicians
Raleigh Radiology LLCGroup PAC ID 6305739707, 61 clinicians

Practice addresses (Care Compare)

10000 Falls of Neuse Rd
Raleigh, NC 27614-7838
Phone (919) 350-7000

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

1705 Tarboro St SW
Wilson, NC 27893-3428
Phone (252) 399-8040

1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone (919) 350-7000

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

5111 Falls of Neuse Rd
Suite 100
Raleigh, NC 27609-4872
Phone (919) 781-1437

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Medical Group, PA PastSince Sep 17, 2023 Accepting new patients

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1548976962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2831 PIEDMONT RIVER WAY",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276067403",
            "telephone_number": "859-324-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128086",
            "telephone_number": "919-781-1437",
            "fax_number": "919-787-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYON",
        "first_name": "CALEB",
        "middle_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-09-11",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.