NPIMap

Organization Active NPI

White Oak Pediatric Associates PA

  • Specialist
  • Raleigh, NC
National Provider Identifier
1902953045
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
21831 Issued in NC
Legal business name
WHITE OAK PEDIATRIC ASSOCIATES PA
Practice address
4414 Lake Boone TRL
Suite 103
Raleigh, NC 27607-7513
Phone
(919) 787-0266
Fax
(919) 571-9314
NPI assigned
Jan 4, 2007
Last updated
Oct 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Authorized official

Name
Mr. Robert Lawrence Munt Jr., MDNPI 1063464485
Title
MD
Phone
(919) 787-0266

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 21831 NC Primary

Addresses

Primary practice location

4414 Lake Boone TRL
Suite 103
Raleigh, NC 27607-7513

Mailing address

4414 Lake Boone TRL
Suite 103
Raleigh, NC 27607-7513
Phone (919) 787-0266

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140311000526 NC Part B Supplier - Clinic/Group Practice 3870723901 Receives reassigned benefits from 3 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory
Tax ID family
White Oak Pediatric Assoc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4144 LK Boone TRL Ste 103
Raleigh, NC 27607

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1902953045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "SUITE 103",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-787-0266",
            "fax_number": "919-571-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 LAKE BOONE TRL",
            "address_2": "SUITE 103",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077513",
            "telephone_number": "919-787-0266",
            "fax_number": "919-571-9314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE OAK PEDIATRIC ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "MUNT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "919-787-0266",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "21831",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 15, 2013; 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.