Wake Primary Care, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2011-01123 Issued in NC

Legal business name

WAKE PRIMARY CARE, PLLC

Practice address

400 Ashville Ave
Suite 315
Cary, NC 27518-6134

Phone

(919) 803-3316

Fax

(919) 803-3354

NPI assigned

Oct 10, 2013

Last updated

Oct 10, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Smith, CREDENTIAL

Title

Credentialing Coordinator

Phone

(919) 342-6842

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1629405550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 COLE CREST CT",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138374",
            "telephone_number": "919-803-3316",
            "fax_number": "919-803-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ASHVILLE AVE",
            "address_2": "SUITE 315",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186134",
            "telephone_number": "919-803-3316",
            "fax_number": "919-803-3354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "919-342-6842",
        "authorized_official_credential": "CREDENTIAL"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2011-01123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917977",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wake Ophthalmology Associates, PA
• Wake Orthopaedics, LLC
• Wake Pediatric Speech Therapy
• Wake Pet Services LLC
• Wake Plastic Surgery, PLLC
• Wake Psychological Associates PLLC
• Wake Specialty Physicians (WSP-Wake Orthopaedics)
• Wake Specialty Physicians (WSP Wellness Family Practice)
• Wake Specialty Physicians LLC
• Wake Specialty Physicians LLC (WakeMed Children's Pediatrics Cary)

• Internal Medicine Physician in Cary, NC
• Providers in Cary, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.