NPIMap

Organization Active NPI

Wake Specialty Physicians, LLC

  • Developmental - Behavioral Pediatrics Physician
  • Raleigh, NC
National Provider Identifier
1659934511
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
WAKE SPECIALTY PHYSICIANS, LLC
Practice address
23 Sunnybrook Rd
Raleigh, NC 27610-1855
Phone
(919) 350-8797
Fax
(919) 350-7859
NPI assigned
Apr 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Authorized official

Name
Maria Jayoussi
Title
Executive VP of Finance
Phone
(919) 350-0554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0006X Primary

Addresses

Primary practice location

23 Sunnybrook Rd
Raleigh, NC 27610-1855

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (877) 498-4490

Other identifiers 1

IdentifierTypeStateIssuer
1942440375MedicaidNC

Other names 1

  • WakeMed Children's-Pediatric Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Falls Pointe Medical Group70 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": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1659934511",
    "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": "877-498-4490",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 SUNNYBROOK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101855",
            "telephone_number": "919-350-8797",
            "fax_number": "919-350-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE VP OF FINANCE",
        "authorized_official_telephone_number": "919-350-0554"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942440375",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Children's-Pediatric Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WakeMed Children's-Pediatric Behavioral Health",
            "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 Jul 24, 2019; 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.