NPIMap

Organization Active NPI

Raleigh Neurosurgical Clinic, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Goldsboro, NC
National Provider Identifier
1801660212
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
RALEIGH NEUROSURGICAL CLINIC, INC.
Practice address
2605 Hospital Rd
Goldsboro, NC 27534-9424
Phone
(919) 785-3400
NPI assigned
Nov 7, 2023
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Jacob A Rodman
Title
Ceo
Phone
(919) 785-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU Primary

Addresses

Primary practice location

2605 Hospital Rd
Goldsboro, NC 27534-9424

Mailing address

5838 Six Forks Rd Ste 100
Raleigh, NC 27609-3893
Phone (919) 716-5383

Other names 1

  • Raleigh Neurosurgical Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250207000269 NC DME Supplier - Physician - NeurosurgeryDME Supplier - Physician - Neurology 1759315500 Practice locations: Goldsboro, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
34D2264639Raleigh Neurosurgical Clinic2605 Hospital Road, Goldsboro, NC 27534Certificate of waiverJul 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Robert Lee Allen MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1902 N Sandhills Blvd
Ste A
Aberdeen, NC 28315

12610 N Community House Rd
Ste 100
Charlotte, NC 28277
Phone (704) 610-3220

600 Village Walk Dr
#A
Holly Springs, NC 27540
Phone (919) 285-2157

1540 Sunday Dr
Ste 301
Raleigh, NC 27607
Phone (919) 277-9837

3700 Barrett Dr
Raleigh, NC 27609

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1699315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1801660212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5838 SIX FORKS RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276093893",
            "telephone_number": "919-716-5383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 HOSPITAL RD",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349424",
            "telephone_number": "919-785-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH NEUROSURGICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-07",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "RODMAN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-785-3400"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raleigh Neurosurgical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.