NPIMap

Organization Active NPI

Wake Specialty Physicians, LLC

Doing business as WakeMed Pediatric Cardiology

  • Pediatric Cardiology Physician
  • Raleigh, NC
National Provider Identifier
1861922775
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
WAKE SPECIALTY PHYSICIANS, LLC
Doing business as
WakeMed Pediatric Cardiology
Practice address
23 Sunnybrook Rd
Raleigh, NC 27610-1855
Phone
(919) 235-6422
Fax
(919) 231-0314
NPI assigned
Jun 13, 2017
Last updated
Jul 21, 2022By the provider in NPPES
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
Maria Jayoussi
Title
Exec Director, Finance
Phone
(919) 350-6089

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X NU Primary

Addresses

Primary practice location

23 Sunnybrook Rd
Raleigh, NC 27610-1855

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (919) 350-0552

Other identifiers 1

IdentifierTypeStateIssuer
1942440375MedicaidNC

Other names 1

  • WakeMed Pediatric Cardiology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wake Specialty Physiciansllc72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861922775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-0552",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 SUNNYBROOK RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101855",
            "telephone_number": "919-235-6422",
            "fax_number": "919-231-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXEC DIRECTOR, FINANCE",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942440375",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Pediatric Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WakeMed Pediatric Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 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.

Verify at the official NPI Registry.