NPIMap

Organization Active NPI

Raleigh Durham Medical Group, PA

  • Family Medicine Physician
  • Shallotte, NC
National Provider Identifier
1720458326
Registry record updated Apr 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RALEIGH DURHAM MEDICAL GROUP, PA
Practice address
4748 Main Street
Shallotte, NC 28470
Phone
(910) 754-2273
Fax
(910) 754-2254
NPI assigned
Sep 25, 2015
Organization subpart
Yes
Parent organization
RALEIGH DURHAM MEDICAL GROUP, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2016

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

Authorized official

Name
David K. Moye
Title
Executive Director
Phone
(919) 233-5956

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

4748 Main Street
Shallotte, NC 28470

Mailing address

5420 Wade Park Blvd
Ste 106
Raleigh, NC 27607-4188
Phone (919) 233-5952

Other identifiers 1

IdentifierTypeStateIssuer
1720458326MedicaidNC

Other names 1

  • Seaside Wellness of Shallotte Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Raleigh Durham Medical66 organizations share this tax ID, including this one
Part of
Raleigh Durham Medical

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

Interoperability endpoints

  • Direct secure messaging: nancymurdock@sws.allscriptsdirect.net
  • Direct secure messaging: hannahnicholson@sws.allscriptsdirect.net
  • Direct secure messaging: deborahvarnam@sws.allscriptsdirect.net

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1720458326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 WADE PARK BLVD",
            "address_2": "STE 106",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276074188",
            "telephone_number": "919-233-5952",
            "fax_number": "919-854-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4748 MAIN STREET",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "28470",
            "telephone_number": "910-754-2273",
            "fax_number": "910-754-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH DURHAM MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RALEIGH DURHAM MEDICAL GROUP, PA",
        "enumeration_date": "2015-09-25",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "MOYE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-233-5956"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720458326",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaside Wellness of Shallotte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shallotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; 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.