Active NPI
Marie-Jacques Marilyn Ambroise, MHS, PA-C
- Physician Assistant
- Raleigh, NC
National Provider Identifier
1790962801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 103679
- Practice address
- 5720 Creedmoor Rd Ste 100
Raleigh, NC 27612-2203 - Phone
- (919) 782-0430
- NPI assigned
- Jan 31, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 103679 | NC | Primary |
Addresses
Primary practice location
5720 Creedmoor Rd Ste 100
Raleigh, NC 27612-2203
Mailing address
201 Stevens Mill Rd
Goldsboro, NC 27530-1056
Phone (919) 731-3206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103679 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vybemed Direct Primary Care, PLLC | Current | Accepting new patients |
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.
-
- Family Medicine Physician
- Concord, NC
- NPI 1477344992
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448409600000",
"number": "1790962801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 STEVENS MILL RD",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275301056",
"telephone_number": "919-731-3206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5720 CREEDMOOR RD STE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276122203",
"telephone_number": "919-782-0430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMBROISE",
"first_name": "MARIE-JACQUES",
"middle_name": "MARILYN",
"name_prefix": "Ms.",
"credential": "MHS, PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-31",
"last_updated": "2015-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "103679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.