PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1144632894) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144632894 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DUKE SPORTS MEDICINE CENTER CLINIC |
| Practice Address |
3475 Erwin Rd Durham NC 27705-0005 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9196845888 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2016-08-09 |
| Authorized Official Name | CHRISTOPHER T FREDERICK (PRACTICE CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9196201055 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Duke Sports Medicine Center Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538616289 | Private Diagnostic Clinic, Pllc | Neurological Surgery | 1212 Cedarhurst Dr Ste 102, Raleigh, NC 27609-5588 | 2016-09-09 |
| 1083168181 | Private Diagnostic Clinic, Pllc | Internal Medicine | 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 | 2016-08-08 |
| 1124459292 | Private Diagnostic Clinic, Pllc | Occupational Therapist | Duke Clinic 1e, 40 Duke Medicine Circle, Durham, NC 27710-0001 | 2013-11-27 |
| 1609116664 | Private Diagnostic Clinic, Pllc | Dermatology | 82 Wheaton Ave, Youngsville, NC 27596-8691 | 2013-02-27 |
| 1487903423 | Private Diagnostic Clinic, Pllc | Pediatrics | 540 New Waverly Place, Ste.101, Cary, NC 27518-7422 | 2012-09-06 |
| 1558639864 | Private Diagnostic Clinic, Pllc | Allergy & Immunology | 30 Duke Medicine Circle, Durham, NC 27710-3000 | 2011-12-01 |
| 1972826568 | Private Diagnostic Clinic, Pllc | Family Medicine | 800 Clayton Rd, Durham, NC 27703-2606 | 2010-03-10 |
| 1891021853 | Private Diagnostic Clinic, Pllc | Obstetrics & Gynecology | 2406 Blue Ridge Road, Suite 200, Raleigh, NC 27607-6680 | 2009-10-27 |
| 1447480413 | Private Diagnostic Clinic, Pllc | Orthopaedic Surgery | 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 | 2009-07-23 |
| 1841446762 | Private Diagnostic Clinic, Pllc | Otolaryngology | 783 Doctors Ct Ste C, Roxboro, NC 27573-4575 | 2008-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRIVATE DIAGNOSTIC CLINIC, PLLC | Duke University Medical Center, Durham, NC 27710-0001 |
| Street Address |
3475 ERWIN RD |
| City | DURHAM |
| State | NC |
| Zip Code | 27705-0005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831114040 | Justin R Lynch | Physician Assistant | 3475 Erwin Rd, Durham, NC 27705-0005 | 2006-07-12 |
| 1588281497 | Thomas John Otley | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2020-06-26 |
| 1649894817 | Cassandra Rhodes | Specialist/Technologist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2020-06-03 |
| 1255964789 | Jeffrey Harrison Wakefield | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2020-02-12 |
| 1104458934 | Logan Edward Chaffin | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2020-02-10 |
| 1790316875 | Courtney A Pyles | Specialist/Technologist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2020-01-28 |
| 1972153419 | Meredith Elise Bland | Physical Medicine & Rehabilitation | 3475 Erwin Rd, Durham, NC 27705-0005 | 2019-09-17 |
| 1780236257 | Drew Henry Lukes | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2019-07-15 |
| 1164991311 | Mary Hollis Dameron | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705-0005 | 2018-11-16 |
| 1699253252 | Christopher Richard Lefever | Physical Therapist | 3475 Erwin Rd, Durham, NC 27705 | 2018-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371755 | Tyler Beach, Lcsw, Pllc | Social Worker | 2740 Spencer Street, Durham, NC 27705 | 2019-11-20 |
| 1720635477 | Brittany W Fry | Registered Nurse | 2301 Erwin Road, Hafs Building, Room 6670, Durham, NC 27705 | 2019-08-19 |
| 1760968044 | Nicole D Moore | Social Worker | 1921 N. Pointe Dr, Suite 280, Durham, NC 27705 | 2018-07-19 |
| 1144757097 | Emileigh S Dowling | Physical Therapist | 3475 Erwin Rd Bldg 2, Durham, NC 27705 | 2017-05-22 |
| 1487195350 | Daniel Lynch | Physical Therapist | 3475 Erwin Road, Pepsico Building, Durham, NC 27705 | 2017-03-13 |
| 1780131839 | Michael A Fitzpatrick Iv | Physical Therapist | 3475 Erwin Rd Bldg 2nd, Durham, NC 27705 | 2016-09-07 |
| 1609241736 | Julia Power Constant | Physician Assistant | Dumc Box 3913, Durham, NC 27705 | 2015-12-01 |
| 1518344159 | Amanda Clark Coniglio | Internal Medicine | 2301 Erwin Rd # 3845, Durham, NC 27705 | 2015-05-04 |
| 1720486988 | Jennifer Dawn Pace | Physician Assistant | 1821 Hillandale Road Suite 24a, Duke Urgent Care, Durham, NC 27705 | 2014-12-19 |
| 1942612106 | Rachel Hibberd | Psychologist | 508 Fulton Avenue, Durham Va Medical Center, Durham, NC 27705 | 2014-05-22 |
| Find all providers in zip 27705 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437546934 | Hari Shankar Mitra | Orthopaedic Surgery | 40 Duke Medicine Cir # 1b1c, Durham, NC 27710-3761 | 2015-04-22 |
| 1275945297 | Jay Paul Willhite | Orthopaedic Surgery | 1905 Childrens Health Ctr Department of Radiology, Durham, NC 27710 | 2014-05-26 |
| 1912263880 | Daniel Mangiapani | Orthopaedic Surgery | 2227 Meade Ln, Durham, NC 27707-2964 | 2012-04-05 |
| 1730356056 | Melissa Maria Erickson | Orthopaedic Surgery | 30 Duke Medicine Cir, Durham, NC 27710-3000 | 2008-05-15 |
| 1134203029 | James Messersmith | Orthopaedic Surgery | 3609 Watkins Rd, Durham, NC 27707-3355 | 2006-10-25 |
| 1548357064 | Robert D Zura | Orthopaedic Surgery | Dumc 3205, Durham, NC 27710-0001 | 2006-10-06 |
| 1740371012 | Richard D. Goldner | Orthopaedic Surgery | 3480 Duke Medical Ctr, Durham, NC 27710-0001 | 2006-09-28 |
| 1225077415 | Kyle E Black | Orthopaedic Surgery | 5616 Denwood Ln, Durham, NC 27705-9252 | 2006-06-05 |
| 1962463125 | Thomas Craig Derian | Orthopaedic Surgery | 4206 N Roxboro Street, Suite 120, Durham, NC 27704-1868 | 2006-03-29 |
| 1447226402 | Russell R. Zelko | Orthopaedic Surgery | 4220 Apex Hwy, Suite 200, Durham, NC 27713 | 2006-02-28 |
| Find all providers in DURHAM | ||||
Please comment or provide details below to improve the information on PRIVATE DIAGNOSTIC CLINIC, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.