NPIMap

Organization Active NPI

Kids First Pediatrics of Raleigh, PLLC

  • Pediatrics Physician
  • Raleigh, NC
National Provider Identifier
1700057486
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDS FIRST PEDIATRICS OF RALEIGH, PLLC
Practice address
4109 Wake Forest Rd Ste 300
Raleigh, NC 27609-2508
Phone
(919) 250-3478
Fax
(919) 250-6272
NPI assigned
Mar 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Selam Bullock, MDNPI 1922194000
Title
Ceo
Phone
(919) 250-3478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

4109 Wake Forest Rd Ste 300
Raleigh, NC 27609-2508

Mailing address

4109 Wake Forest Rd Ste 300
Raleigh, NC 27609-2508
Phone (919) 250-3478

Other practice location 1

400 Athletic Club Blvd Unit 101
Clayton, NC 27527-6558
Phone (919) 267-1499

Other identifiers 1

IdentifierTypeStateIssuer
5913770MedicaidNC

Other names 1

  • Kids First Pediatrics of Clayton Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1102160Kids First Pediatrics of Raleigh, PLLC4109 Wake Forest Rd, Ste 300, Raleigh, NC 27609Certificate of waiverJul 13, 2027

National Provider Directory

National Provider Directory

Locations

400 Athletic Club Blvd
Ste 101
Clayton, NC 27527

400 Athletic Club Blvd
Unit 101
Clayton, NC 27527
Phone (919) 267-1499

400 Athletic Club Blvd
#101
Clayton, NC 27527

23 Sunnybrook Rd
Ste 116
Raleigh, NC 27610
Phone (919) 250-3478

4109 Wake Forest Rd
Ste 300
Raleigh, NC 27609
Phone (919) 250-3478

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HHHGAA

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1700057486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 WAKE FOREST RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276092508",
            "telephone_number": "919-250-3478",
            "fax_number": "919-250-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 WAKE FOREST RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276092508",
            "telephone_number": "919-250-3478",
            "fax_number": "919-250-6272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Athletic Club Blvd Unit 101",
            "address_purpose": "LOCATION",
            "city": "Clayton",
            "state": "NC",
            "postal_code": "275276558",
            "country_code": "US",
            "telephone_number": "919-267-1499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDS FIRST PEDIATRICS OF RALEIGH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "SELAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-250-3478",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913770",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids First Pediatrics of Clayton",
            "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 Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.