Individual provider Active NPI

Persia Freshteh Hadad, PA-C

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1760156095
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11501 Issued in NC
Practice address
2601 Lake Dr Ste 201
Raleigh, NC 27607-6689
Phone
(919) 783-4888
Fax
(919) 783-4887
NPI assigned
Aug 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 0010-11501 NC Primary

Addresses

Primary practice location

2601 Lake Dr Ste 201
Raleigh, NC 27607-6689

Mailing address

PO Box 18563
Raleigh, NC 27619-8563
Phone (919) 782-1806

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
I20210930002422 NC Practitioner - Physician Assistant 4688071855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raleigh Medical Group PAGroup PAC ID 6800874322, 99 clinicians

Practice addresses (Care Compare)

2601 Lake Dr
Suite 201
Raleigh, NC 27607-6689
Phone (919) 783-4888

3521 Haworth Dr
Raleigh, NC 27609-7244
Phone (919) 782-1806

929 Kildaire Farm Rd
Cary, NC 27511-3922

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-11501NCMDPhysician Assistant

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1760156095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18563",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276198563",
            "telephone_number": "919-782-1806",
            "fax_number": "919-782-4756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 LAKE DR STE 201",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076689",
            "telephone_number": "919-783-4888",
            "fax_number": "919-783-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADAD",
        "first_name": "PERSIA",
        "middle_name": "FRESHTEH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2024-01-23",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.