Individual provider Active NPI

Juliana Rae Wulforst, PA

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1619608635
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12593 Issued in NC
Practice address
3024 New Bern Ave Ste 304
Raleigh, NC 27610-1247
Phone
(919) 350-7331
NPI assigned
Jun 21, 2022
Last updated
Oct 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 0010-12593 NC Primary

Addresses

Primary practice location

3024 New Bern Ave Ste 304
Raleigh, NC 27610-1247

Mailing address

801 Moratuck Dr Apt 307
Raleigh, NC 27604-1447
Phone (919) 428-0871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221024002813 NC Practitioner - Physician Assistant 2567838089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone (919) 350-8000

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-12593NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Oct 10, 2022 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Oct 10, 2022 Accepting new patients
Wake Specialty Physicians, LLC Surgery PastSince Jun 26, 2022 Accepting new patients

Locations

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

3024 New Bern Ave
Ste 304
Raleigh, NC 27610
Phone (919) 350-7331

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 2

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": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1619608635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 MORATUCK DR APT 307",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276041447",
            "telephone_number": "919-428-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 NEW BERN AVE STE 304",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101247",
            "telephone_number": "919-350-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WULFORST",
        "first_name": "JULIANA",
        "middle_name": "RAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "0010-12593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.