Individual provider Active NPI

Jessica Ely Prue, PA-C

  • Surgical Physician Assistant
  • Raleigh, NC
National Provider Identifier
1871103382
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0010-12366 Issued in NC
Practice address
3009 New Bern Ave
Raleigh, NC 27610-1214
Phone
(919) 232-5020
Fax
(919) 232-5021
NPI assigned
Aug 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-12366 NC
Surgical Physician Assistant 363AS0400X 0010-12366 NC Primary

Addresses

Primary practice location

3009 New Bern Ave
Raleigh, NC 27610-1214

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-2266

Other identifiers 1

IdentifierTypeStateIssuer
1871103382MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221015000264 NC Practitioner - Physician Assistant 0648690693 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

10000 Falls of Neuse Rd
Raleigh, NC 27614-7838
Phone (919) 350-8000

1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone (919) 350-8000

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-12366NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Aug 18, 2025 Accepting new patients
Raleigh Orthopaedic Clinic PA CurrentSince Oct 1, 2022 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Aug 18, 2025 Accepting new patients

Locations

115 Kildaire Park Dr
Ste 102
Cary, NC 27518
Phone (919) 863-6856

6715 McCrimmon Pkwy
Ste 205A
Cary, NC 27519
Phone (984) 974-5700

6715 McCrimmon Pkwy
Ste 205
Cary, NC 27519
Phone (910) 997-3733

1325 Timber Dr E
Garner, NC 27529
Phone (919) 863-6856

781 Avent Ferry Rd
Ste 110
Holly Springs, NC 27540
Phone (919) 645-1411

3009 New Bern Ave
Raleigh, NC 27610
Phone (919) 232-5021

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3515 Glenwood Ave
Raleigh, NC 27612
Phone 91978156006856

3001 Edwards Mill Rd
Ste 200
Raleigh, NC 27612
Phone (919) 863-6852

11200 Governor Manly Way
Ste 309
Raleigh, NC 27614
Phone 9195629410247

Interoperability endpoints

  • Direct secure messaging: jely581430@directhisp.wakemed.org

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1871103382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101214",
            "telephone_number": "919-232-5020",
            "fax_number": "919-232-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUE",
        "first_name": "JESSICA",
        "middle_name": "ELY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12366",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-12366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871103382",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.