NPIMap

Organization Active NPI

Wake Forest Pediatric Associates, PLLC

  • Pediatrics Physician
  • Wake Forest, NC
National Provider Identifier
1790782126
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAKE FOREST PEDIATRIC ASSOCIATES, PLLC
Practice address
1655 Wake Drive
Suite 101
Wake Forest, NC 27587-7324
Phone
(919) 556-1541
Fax
(919) 556-5277
NPI assigned
Jun 30, 2005
Organization subpart
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

Authorized official

Name
Naomi WeinsteinNPI 1639176100
Title
Manager of Corp
Phone
(919) 556-1541

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 NC Primary

Addresses

Primary practice location

1655 Wake Drive
Suite 101
Wake Forest, NC 27587-7324

Mailing address

1655 Wake Drive
Suite 101
Wake Forest, NC 27587-7324
Phone (919) 556-1541

Other identifiers 1

IdentifierTypeStateIssuer
89012T6MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130827000414 NC Part B Supplier - Clinic/Group Practice 6709029523 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
Practice locations: Wake Forest, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
34D0913096Wake Forest Pediatric Associates, PLLC1655 Wake Drive, Suite 101, Wake Forest, NC 27587ComplianceFeb 12, 2028

National Provider Directory

National Provider Directory

Locations

4019 Village Park Dr
Knightdale, NC 27545
Phone (919) 266-3700

6845 Knightdale Blvd
Ste 100
Knightdale, NC 27545
Phone (919) 266-5059

6845 Knightdale Blvd
Knightdale, NC 27545
Phone (919) 844-6611

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790782126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 WAKE DRIVE",
            "address_2": "SUITE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877324",
            "telephone_number": "919-556-1541",
            "fax_number": "919-556-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 WAKE DRIVE",
            "address_2": "SUITE 101",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877324",
            "telephone_number": "919-556-1541",
            "fax_number": "919-556-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST PEDIATRIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WEINSTEIN",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "MANAGER OF CORP",
        "authorized_official_telephone_number": "919-556-1541"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012T6",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.