NPIMap

Organization Active NPI

Raleigh Durham Medical Group PA

  • Family Medicine Physician
  • Hillsborough, NC
National Provider Identifier
1891704789
Registry record updated Mar 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RALEIGH DURHAM MEDICAL GROUP PA
Practice address
101 East Corbin St
Hillsborough, NC 27278
Phone
(919) 643-7603
Fax
(919) 643-7607
NPI assigned
Aug 7, 2006
Organization subpart
Yes
Parent organization
RALEIGH DURHAM MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2009

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

Authorized official

Name
David K Moye
Title
Senior Vice President
Phone
(919) 951-2174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

101 East Corbin St
Hillsborough, NC 27278

Mailing address

5420 Wade Park Blvd
Ste 106
Raleigh, NC 27607-4188
Phone (919) 851-2174

Other identifiers 2

IdentifierTypeStateIssuer
8976543MedicaidNC
76543OtherNCBCBS

Other names 1

  • Hillsborough Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000155 NC Part B Supplier - Clinic/Group Practice 2365409588 Receives reassigned benefits from 103 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Four Oaks, NC; Greenville, NC; Morrisville, NC; Raleigh, NC; Wake Forest, NC; Cary, NC; Fayetteville, NC…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Raleigh Durham Medical

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1891704789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5420 WADE PARK BLVD",
            "address_2": "STE 106",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276074188",
            "telephone_number": "919-851-2174",
            "fax_number": "919-854-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 EAST CORBIN ST",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "27278",
            "telephone_number": "919-643-7603",
            "fax_number": "919-643-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RALEIGH DURHAM MEDICAL GROUP PA",
        "enumeration_date": "2006-08-07",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "MOYE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "919-951-2174"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8976543",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "76543",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillsborough Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillsborough, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.