NPIMap

Organization Active NPI

North Carolina Nephrology PA

  • Nephrology Physician
  • Fuquay Varina, NC
National Provider Identifier
1558865402
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTH CAROLINA NEPHROLOGY PA
Practice address
916 S Main St Ste 240
Fuquay Varina, NC 27526-2420
Phone
(919) 231-3966
Fax
(919) 231-3912
NPI assigned
Mar 23, 2018
Last updated
Sep 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Authorized official

Name
Jennifer Capps
Title
Billing Manager
Phone
(919) 231-3966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

916 S Main St Ste 240
Fuquay Varina, NC 27526-2420

Mailing address

3700 Barrett Dr Ste 200
Raleigh, NC 27609-7213
Phone (919) 231-3966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170103000254 NC Part B Supplier - Clinic/Group Practice 0244511483 Receives reassigned benefits from 68 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, NC; Wilson, NC; Wake Forest, NC; Smithfield, NC; Louisburg, NC; Fuquay Varina, NC; Dunn, NC; Cary, NC

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
North Carolina Nephrology PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

916 S Main St
Ste 240
Fuquay Varina, NC 27526
Phone (919) 235-0644

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1558865402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BARRETT DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097213",
            "telephone_number": "919-231-3966",
            "fax_number": "919-231-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 S MAIN ST STE 240",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262420",
            "telephone_number": "919-231-3966",
            "fax_number": "919-231-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CAROLINA NEPHROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-23",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "CAPPS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "919-231-3966"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fuquay Varina, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.