Individual provider Active NPI

Rexford Reynold Fisher III, PA-C

  • Medical Physician Assistant
  • Raleigh, NC
National Provider Identifier
1629685912
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
6615 Academic Ave
Raleigh, NC 27616-8094
Phone
(585) 694-0715
NPI assigned
Sep 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0010-11302 NC
Physician Assistant 363A00000X 0010-11302 NC
Surgical Physician Assistant 363AS0400X 0010-11302 NC
Student in an Organized Health Care Education/Training Program 390200000X
Medical Physician Assistant 363AM0700X NC Primary

Addresses

Primary practice location

6615 Academic Ave
Raleigh, NC 27616-8094

Mailing address

6615 Academic Ave
Raleigh, NC 27616-8094
Phone (585) 694-0715

Other practice location 1

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rfisher732224@direct.UNC.nchie.net Direct

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
I20210721001826 NC Practitioner - Physician Assistant 7113320607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

1830 Fordham Blvd
Suite 100
Chapel Hill, NC 27514-2301
Phone (919) 364-3312

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

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

4420 Lake Boone TRL
Raleigh, NC 27607-7505

509 N Brightleaf Blvd
Smithfield, NC 27577-4407
Phone (984) 215-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Nov 13, 2023 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Nov 13, 2023 Accepting new patients
Rex Hospital Inc Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: rfisher732224@direct.unc.nchie.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1629685912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 ACADEMIC AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276168094",
            "telephone_number": "585-694-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 ACADEMIC AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276168094",
            "telephone_number": "585-694-0715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 New Bern Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101231",
            "country_code": "US",
            "telephone_number": "919-350-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FISHER",
        "first_name": "REXFORD",
        "middle_name": "REYNOLD",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-30",
        "last_updated": "2023-12-01",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "0010-11302",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11302",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-11302",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rfisher732224@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "509 N Brightleaf Blvd",
            "city": "Smithfield",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275774407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.