Western Wake Internal Medicine

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

9801744 Issued in NC

Legal business name

WESTERN WAKE INTERNAL MEDICINE

Practice address

907 Kildaire Farm Rd
Cary, NC 27511-3922

Phone

(919) 319-6610

NPI assigned

Jul 6, 2010

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Sr Director Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Tri - State Medical Group Inc

Practitioners 1

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

• Raj Polavaram, MD

  • Internal Medicine Physician
  • Cary, NC
  • NPI 1336289065
  NPD

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1811209901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "address_2": "100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 KILDAIRE FARM RD",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275113922",
            "telephone_number": "919-319-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN WAKE INTERNAL MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2010-07-06",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR DIRECTOR OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "9801744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca West
• Teoletta Suzette West, LCSW
• Western Wake Counseling & Psychological Services, PLLC
• Western Wake Eye Center PA
• Western Wake Internal Medicine
• Western Wake Medical Associates, PLLC
• Western Wake Pediatrics, PA
• Western Wake Surgical PC
• Western Wake Wellness
• Taniya Westmoreland, BEHAVIOR TECHNICIAN

• Non-Pharmacy Dispensing Site in Cary, NC
• Providers in Cary, NC by specialty
• Non-Pharmacy Dispensing Site in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.