NPIMap

Organization Active NPI

Growing Child Pediatrics, PA

  • Pediatrics Physician
  • Wake Forest, NC
National Provider Identifier
1649239351
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
76741 Issued in NC
Legal business name
GROWING CHILD PEDIATRICS, PA
Practice address
11130 Capital Blvd
Wake Forest, NC 27587-4513
Phone
(919) 488-4094
Fax
(919) 488-4096
NPI assigned
Mar 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

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

Authorized official

Name
Dr. James Morrison Poole, M.D.
Title
Owner
Phone
(919) 488-0015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 76741 NC Primary

Addresses

Primary practice location

11130 Capital Blvd
Wake Forest, NC 27587-4513

Mailing address

260 Horizon Dr
Raleigh, NC 27615-4922
Phone (919) 488-0015

Other identifiers 5

IdentifierTypeStateIssuer
6006881MedicaidNC
6008735MedicaidNC
6008736MedicaidNC
6008733MedicaidNC
890137QMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Growing Child Pediatrics11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

260 Horizon Dr
Raleigh, NC 27615
Phone (919) 488-0015

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1649239351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 HORIZON DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154922",
            "telephone_number": "919-488-0015",
            "fax_number": "919-277-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11130 CAPITAL BLVD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874513",
            "telephone_number": "919-488-4094",
            "fax_number": "919-488-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROWING CHILD PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MORRISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-488-0015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "76741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006881",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008735",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008736",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008733",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890137Q",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.