WAKE SPECIALTY PHYSICIANS LLC (NPI# 1225449168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225449168 |
| Entity Type | Organization |
| Organization Name | WAKE SPECIALTY PHYSICIANS LLC |
| Other Organization Name | WAKEMED PRIMARY CARE KNIGHTDALE |
| Practice Address |
901 Old Knight Rd Knightdale NC 27545-9065 |
| Mailing Address |
Po Box 602195 Charlotte NC 28260-2195 |
| Practice Telephone | 9192666211 |
| Practice Fax Number | 9193509824 |
| Mailing Telephone | 9193500554 |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2019-08-08 |
| Authorized Official Name | MARIA JAYOUSSI (EXECUTIVE DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 9193506089 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1225449168 | 05 |
| Other Name | Type Code |
|---|---|
| WakeMed Physician Practices Primary Care Knightdale | Doing Business As Name - Organization |
| WakeMed Primary Care Knightdale | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225684004 | Wake Specialty Physicians LLC | Internal Medicine | 11640 Northpark Dr, Wake Forest, NC 27587-5741 | 2019-08-16 |
| 1841713187 | Wake Specialty Physicians LLC | Internal Medicine | 3000 New Bern Ave Ste 1200, Raleigh, NC 27610-1231 | 2017-07-19 |
| 1740702497 | Wake Specialty Physicians LLC | Internal Medicine | 101 Cotten Ln, Holly Springs, NC 27540-8415 | 2017-07-14 |
| 1407267347 | Wake Specialty Physicians LLC | Family Medicine | 3020 New Bern Ave, Raleigh, NC 27610-1215 | 2014-05-14 |
| 1699186619 | Wake Specialty Physicians LLC | Family Medicine | 150 E Davie St, Raleigh, NC 27601-1806 | 2014-05-13 |
| 1346501673 | Wake Specialty Physicians LLC | Internal Medicine | 400 Us Highway 70 East, Garner, NC 27529-4049 | 2012-06-04 |
| 1427604149 | Wake Specialty Physicians LLC | Family Medicine | 7560 Carpenter Fire Station Rd, Cary, NC 27519-9637 | 2019-08-19 |
| 1871052597 | Wake Specialty Physicians LLC | Internal Medicine | 222 Ashville Ave, Cary, NC 27518-6130 | 2019-03-13 |
| 1649741950 | Wake Specialty Physicians LLC | Otolaryngology | 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 | 2018-12-13 |
| 1912478496 | Wake Specialty Physicians LLC | Surgery | 530 New Waverly Pl, Cary, NC 27518-7414 | 2018-12-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Wake Specialty Physicians LLC | 3000 New Bern Avenue, Raleigh, NC 27610-1231 |
| Street Address |
901 OLD KNIGHT RD |
| City | KNIGHTDALE |
| State | NC |
| Zip Code | 27545-9065 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639688526 | Galberth Health | Physical Therapist | 8002 Peachtree Town Ln, Knightdale, NC 27545 | 2017-09-24 |
| 1790215390 | Edward Hoggard Jr. | Counselor | 2013 Ballston Place, Knightdale, NC 27545 | 2017-06-15 |
| 1730635970 | Tara Forsythe | Social Worker | 4006 Peachtree Town Lane, Knightdale, NC 27545 | 2016-08-28 |
| 1134504962 | Maybell Grino | Pharmacist | 7201 Us Highway 64, Knightdale, NC 27545 | 2015-07-22 |
| 1477948735 | Q1 Clinical Consultants, LLC | Community/Behavioral Health | 1408 Silver Valley Dr, Knightdale, NC 27545 | 2015-04-03 |
| 1235560772 | Shameka Latoya Davis | Counselor | 7417 Knightdale Blvd Unit 101, Knightdale, NC 27545 | 2013-12-10 |
| 1992135107 | Daniel Ross Conti | Dentist | 1001 Widewaters Parkway, Knightdale, NC 27545 | 2013-11-25 |
| 1255773644 | David D Sanjurjo | Nurse Practitioner | 7201 Us Hwy 64, Knightdale, NC 27545 | 2013-07-25 |
| 1790037133 | Dona D Mayo | Counselor | 502 Mcknight Drive, Better Communities, Knightdale, NC 27545 | 2012-10-09 |
| 1699972257 | Lindsay Horwat | Occupational Therapist | 1010 Emerald Common Drive, Apartment 205, Knightdale, NC 27545 | 2007-06-28 |
| Find all providers in zip 27545 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306899125 | Raleigh Durham Medical Group Pa | Family Medicine | 7124 Knightdale Blvd, Knightdale, NC 27545-9265 | 2006-05-19 |
| 1124070529 | Jeffrey M Keil | Family Medicine | 6602 Knightdale Blvd Ste 102, Knightdale, NC 27545 | 2006-05-16 |
| 1013989862 | William Grant Jr. | Family Medicine | 6602 Knightdale Blvd Ste 202, Knightdale, NC 27545-6526 | 2006-02-06 |
| 1154305548 | Robert Stark Adams Jr. | Family Medicine | 6905 Knightdale Blvd, Ste 106, Knightdale, NC 27545-6505 | 2005-11-30 |
| 1740279033 | John K Campbell | Family Medicine | 162 Legacy Oaks Dr, Suite 102, Knightdale, NC 27545-6556 | 2005-10-19 |
| 1790789394 | Linwood Worth Watson | Family Medicine | 6602 Knightdale Blvd, Suite 102, Knightdale, NC 27545-7130 | 2005-06-10 |
| 1649757113 | Heather Johnson Lawson | Family Medicine | 6602 Knightdale Blvd Ste 202, Knightdale, NC 27545-6526 | 2018-07-26 |
| 1659649663 | Minal Prashant Desai | Family Medicine | 162 Legacy Oaks Dr, Knightdale, NC 27545-6556 | 2011-12-05 |
| 1164710810 | Unc Physicians Network, LLC | Family Medicine | 6602 Knightdale Blvd Ste 202, Knightdale, NC 27545-6526 | 2011-07-15 |
| 1790002418 | Matthew David Oettinger | Family Medicine | 6602 Knightdale Blvd, Suite 202, Knightdale, NC 27545-6525 | 2010-04-21 |
| Find all providers in KNIGHTDALE | ||||
| City | KNIGHTDALE |
| Zip Code | 27545 |
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| 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.