NPIMap

Organization Active NPI

Wake Specialty Phisicians, LLC

Doing business as WakeMed General Surgery

  • Surgery Physician
  • Raleigh, NC
National Provider Identifier
1609287622
Registry record updated Sep 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
WAKE SPECIALTY PHISICIANS, LLC
Doing business as
WakeMed General Surgery
Practice address
3024 New Bern Ave
Raleigh, NC 27610-1247
Phone
(919) 350-7331
Fax
(919) 871-1228
NPI assigned
May 13, 2014
Last updated
Sep 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2016

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

Authorized official

Name
Maria Jayoussi
Title
Executive Director
Phone
(919) 350-6089

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

3024 New Bern Ave
Raleigh, NC 27610-1247

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0554

Other identifiers 1

IdentifierTypeStateIssuer
1942440375MedicaidNC

Other names 1

  • WakeMed General Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Falls Pointe Medical Group72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473638400000",
    "number": "1609287622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101247",
            "telephone_number": "919-350-7331",
            "fax_number": "919-871-1228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHISICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2016-09-12",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942440375",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.