NPIMap

Organization Active NPI

Wakemed Specialists Group, LLC

  • Durable Medical Equipment & Medical Supplies
  • Garner, NC
National Provider Identifier
1992360960
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WAKEMED SPECIALISTS GROUP, LLC
Practice address
400 US Highway 70 E
Ste 100
Garner, NC 27529-4850
Phone
(919) 232-5020
Fax
(919) 232-5021
NPI assigned
May 6, 2019
Last updated
Aug 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 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 of Finance
Phone
(919) 350-6089

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

400 US Highway 70 E
Ste 100
Garner, NC 27529-4850

Mailing address

PO Box 603949
Charlotte, NC 28260-3949
Phone (919) 350-0552

Other names 1

  • WakeMed Wake Orthopaedics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190910001430 NC DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2466788377 Practice locations: Garner, NC

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Wakemed Specialists Group L36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

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

NPI Registry JSON

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1992360960",
    "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": "919-350-0552",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 US HIGHWAY 70 E",
            "address_2": "STE 100",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275294850",
            "telephone_number": "919-232-5020",
            "fax_number": "919-232-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEMED SPECIALISTS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "JAYOUSSI",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "919-350-6089"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WakeMed Wake Orthopaedics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "WakeMed Wake Orthopaedics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Garner, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.