NPIMap

Organization Active NPI

Wake Specialty Physicians, LLC

  • Surgery Physician
  • Raleigh, NC
National Provider Identifier
1942440375
Registry record updated Apr 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
WAKE SPECIALTY PHYSICIANS, LLC
Practice address
3000 New Bern Ave
Raleigh, NC 27610-1231
Phone
(919) 350-8228
Fax
(919) 350-7976
NPI assigned
Feb 25, 2009
Last updated
Apr 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2019

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

Authorized official

Name
Maria Jayoussi
Title
Executive Director
Phone
(919) 350-6089

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3000 New Bern Ave
Raleigh, NC 27610-1231

Mailing address

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8228

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090601000520 NC Part B Supplier - Clinic/Group Practice 7416006085 Receives reassigned benefits from 283 practitioners
43 other NPIs on this enrollment

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Wakemed

    dba WakeMed Mental Health & Well-Being Hospital WakeBrook

    • Psychiatric Hospital Unit
    • Raleigh, NC
    • NPI 1780446302

    Member Of

    NPD member

Locations (25 of 51)

10000 Cambridge Village Loop
#3312
Apex, NC 27502

120 Healthplex Way
Ste 220
Apex, NC 27502
Phone (919) 350-0550

1 Medical Dr
Benson, NC 27504
Phone (919) 207-1027

100 Ridge View Dr
Cary, NC 27511
Phone (910) 219-8310

1505 SW Cary Pkwy
Ste 100
Cary, NC 27511
Phone (919) 415-1360

200 Ashville Ave
Cary, NC 27518
Phone (919) 232-5202

200 Ashville Ave
Ste 30
Cary, NC 27518
Phone (919) 350-2580

204 Ashville Ave
Cary, NC 27518
Phone (919) 235-6460

208 Ashville Ave
Cary, NC 27518
Phone (919) 350-9625

208 Ashville Ave
Ste 14
Cary, NC 27518
Phone (919) 350-9625

126 Pritchard Rd
Clayton, NC 27527
Phone (919) 235-1036

12701 US Highway 70 Bus W
Clayton, NC 27520
Phone (919) 235-1968

166 Springbrook Ave
Ste 205
Clayton, NC 27520

800 Tilghman Dr
Ste 400
Dunn, NC 28334

803 Tilghman Dr
Ste 400
Dunn, NC 28334
Phone (910) 230-2920

400 US 70 Hwy E
Ste 200
Garner, NC 27529
Phone (919) 235-6400

400 US 70 Hwy E
Ste 202
Garner, NC 27529
Phone (919) 235-6400

500 Holly Springs Rd
Ste 105
Holly Springs, NC 27540
Phone (919) 552-5845

6103 Grace Park Dr
Morrisville, NC 27560

6104 Grace Park Dr
Morrisville, NC 27560

10000 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1630

10000 Falls of Neuse Rd
Ste 206
Raleigh, NC 27614

10010 Falls of Neuse Rd
Ste 105
Raleigh, NC 27614
Phone (919) 350-1570

10010 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1380

10010 Falls of Neuse Rd
Ste 300
Raleigh, NC 27614
Phone (919) 848-6946

Practitioners & affiliated clinicians

Practitioners 449

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 449

NPI Registry JSON

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555891200000",
    "number": "1942440375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-8228",
            "fax_number": "919-350-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101231",
            "telephone_number": "919-350-8228",
            "fax_number": "919-350-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE SPECIALTY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2019-04-22",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Apr 22, 2019; 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.