Individual provider Active NPI

Hazel Ann M Doronila, PA

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1750661765
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06898 Issued in NC
Practice address
2800 Blue Ridge Rd Ste 201
Raleigh, NC 27607-6477
Phone
(919) 784-7110
Fax
(919) 784-7111
NPI assigned
Aug 22, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 015026 NY
Physician Assistant 363A00000X 0010-06898 NC Primary

Addresses

Primary practice location

2800 Blue Ridge Rd Ste 201
Raleigh, NC 27607-6477

Mailing address

2800 Blue Ridge Rd Ste 201
Raleigh, NC 27607-6477
Phone (919) 784-7110

Other practice location 1

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-4000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hdoronila300105@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170720002111 NC Practitioner - Physician Assistant 2668619206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

2800 Blue Ridge Rd
Raleigh, NC 27607-6477

4420 Lake Boone TRL
Raleigh, NC 27607-7505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06898NCMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: hdoronila300105@direct.unc.nchie.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1750661765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 BLUE RIDGE RD STE 201",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076477",
            "telephone_number": "919-784-7110",
            "fax_number": "919-784-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 BLUE RIDGE RD STE 201",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076477",
            "telephone_number": "919-784-7110",
            "fax_number": "919-784-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146213001",
            "country_code": "US",
            "telephone_number": "585-922-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORONILA",
        "first_name": "HAZEL ANN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-22",
        "last_updated": "2022-07-21",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "015026",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hdoronila300105@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "2800 Blue Ridge Rd Ste 201",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276076477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.