NPIMap

Organization Active NPI

Raleigh Adult Medicine PA

  • Internal Medicine Physician
  • Raleigh, NC
National Provider Identifier
1902840762
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RALEIGH ADULT MEDICINE PA
Practice address
3200 Blue Ridge Rd
Ste 210
Raleigh, NC 27612-8086
Phone
(919) 781-9979
Fax
(919) 781-0124
NPI assigned
Jun 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Georgia Hogan
Title
Practice Administrator
Phone
(919) 781-9979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3200 Blue Ridge Rd
Ste 210
Raleigh, NC 27612-8086

Mailing address

3200 Blue Ridge Rd
Ste 210
Raleigh, NC 27612-8086
Phone (919) 781-9979

Other identifiers 2

IdentifierTypeStateIssuer
02360OtherNCBCBS NC GROUP NUMBER
5902360MedicaidNC

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
34D0897937Raleigh Adult Medicine3200 Blue Ridge Rd Ste 210, Raleigh, NC 27612Certificate of waiverFeb 20, 2027

National Provider Directory

National Provider Directory

Locations

3200 Blue Ridge Rd
Ste 210
Raleigh, NC 27612
Phone (919) 781-9979

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902840762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD",
            "address_2": "STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128086",
            "telephone_number": "919-781-9979",
            "fax_number": "919-781-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 BLUE RIDGE RD",
            "address_2": "STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276128086",
            "telephone_number": "919-781-9979",
            "fax_number": "919-781-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH ADULT MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "919-781-9979"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC GROUP NUMBER",
            "identifier": "02360",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902360",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.