Active NPI
Private Diagnostic Clinic, PLLC
- Sports Medicine (Orthopaedic Surgery) Physician
- Cary, NC
National Provider Identifier
1770224875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician
- Legal business name
- PRIVATE DIAGNOSTIC CLINIC, PLLC
- Practice address
- 100 Duke Health Cary Place
Suite 120
Cary, NC 27519 - Phone
- (919) 385-8120
- Fax
- (919) 385-9500
- NPI assigned
- Apr 5, 2022
- Organization subpart
- Yes
- Parent organization
- PRIVATE DIAGNOSTIC CLINIC, PLLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Christopher Thomas Frederick
- Title
- Cfo
- Phone
- (919) 613-7762
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | Primary | ||
| Prosthetic/Orthotic Supplier | 335E00000X |
Addresses
Primary practice location
100 Duke Health Cary Place
Suite 120
Cary, NC 27519
Mailing address
PO Box 110566
Durham, NC 27709-5566
Phone (919) 620-4855
Other names 1
- Duke Sports Medicine Green Level
National Provider Directory
National Provider Directory- Part of
- Cabarrus Memorial Hospi
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1652745600000",
"number": "1770224875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 110566",
"city": "DURHAM",
"state": "NC",
"postal_code": "277095566",
"telephone_number": "919-620-4855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DUKE HEALTH CARY PLACE",
"address_2": "SUITE 120",
"city": "CARY",
"state": "NC",
"postal_code": "27519",
"telephone_number": "919-385-8120",
"fax_number": "919-385-9500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
"enumeration_date": "2022-04-05",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A",
"authorized_official_last_name": "FREDERICK",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_middle_name": "THOMAS",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "919-613-7762"
},
"taxonomies": [
{
"code": "207XX0005X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Duke Sports Medicine Green Level",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Duke Sports Medicine Green Level",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.