Latonja M. Ivery, M. D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2004-01519 Issued in NC

Practice address

1001 Stadium Drive
Ste 104
Wake Forest, NC 27587

Phone

(919) 623-5939

NPI assigned

Jan 9, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of North Carolina at Chapel Hill School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: livery34905@fastmed.direct-ci.com

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.

• Avance Care, PA

  • Clinic/Center
  • Fuquay Varina, NC
  • NPI 1487845020
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1699824607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10900 WORLD TRADE BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27617",
            "telephone_number": "919-237-1337",
            "fax_number": "919-237-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 STADIUM DRIVE",
            "address_2": "STE 104",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "27587",
            "telephone_number": "919-623-5939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3213 Rogers Rd",
            "address_purpose": "LOCATION",
            "city": "Wake Forest",
            "state": "NC",
            "postal_code": "27587",
            "country_code": "US",
            "telephone_number": "919-562-2288",
            "fax_number": "919-562-2225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IVERY",
        "first_name": "LATONJA",
        "middle_name": "M.",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2004-01519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900011",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Melissa Ann Jackson-Westbrook, PSY.D.
• Carim Jackson
• Anitha Kamla Jain-Rodriguez, M.D.
• John Blaine Jarema, MA, CRC, LPC, CLCP
• Jason T Gladwell D.D,S., P.a.

• Family Medicine Physician in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.