WAKEMED SPECIALISTS GROUP, LLC (NPI# 1407409543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407409543 |
| Entity Type | Organization |
| Organization Name | WAKEMED SPECIALISTS GROUP, LLC |
| Other Organization Name | WAKEMED CHILDRENS PEDIATRIC PULMONOLOGY |
| Practice Address |
104 Medspring Dr Clayton NC 27520-9687 |
| Mailing Address |
Po Box 603949 Charlotte NC 28260-3949 |
| Practice Telephone | 9192356535 |
| Mailing Telephone | 9193500554 |
| Mailing Fax Number | 9193507687 |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2020-02-06 |
| 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 |
|---|---|---|---|---|---|
| Y | 2080P0214X |
Pediatrics Specialization: Pediatric Pulmonology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1407409543 | 05 |
| Other Name | Type Code |
|---|---|
| WakeMed Children's-Pediatric Pulmonology | Other Name - Individual/Organization |
| WakeMed Childrens Pediatric Pulmonology | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326681164 | Wakemed Specialists Group, LLC | Durable Medical Equipment & Medical Supplies | 2930 Forestville Rd Ste 100, Raleigh, NC 27616-8774 | 2019-10-24 |
| 1114582301 | Wakemed Specialists Group, LLC | Physical Therapist | 10010 Falls of Neuse Rd Ste 9, Raleigh, NC 27614-8495 | 2019-05-03 |
| 1376108522 | Wakemed Specialists Group, LLC | Orthopaedic Surgery | 8001 T W Alexander Dr Ste 224, Raleigh, NC 27617-4884 | 2019-05-03 |
| 1326684077 | Wakemed Specialists Group, LLC | Clinic/Center | 811 Us 70 Hwy W, Garner, NC 27529-2541 | 2019-11-18 |
| 1013552322 | Wakemed Specialists Group, LLC | Clinic/Center | 231 N Judd Pkwy Ne, Fuquay Varina, NC 27526-2694 | 2019-11-11 |
| 1588225759 | Wakemed Specialists Group, LLC | Preventive Medicine | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-06-27 |
| 1184289159 | Wakemed Specialists Group, LLC | Clinic/Center | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2019-05-06 |
| 1992360960 | Wakemed Specialists Group, LLC | Orthopaedic Surgery | 400 Us Highway 70 E, Ste 100, Garner, NC 27529-4850 | 2019-05-06 |
| 1720643927 | Wakemed Specialists Group, LLC | Otolaryngology | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| 1457916603 | Wakemed Specialists Group, LLC | Orthopaedic Surgery | 120 Healthplex Way Ste 206, Apex, NC 27502-8403 | 2019-05-03 |
| Street Address |
104 MEDSPRING DR |
| City | CLAYTON |
| State | NC |
| Zip Code | 27520-9687 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336750959 | Ebony Nichole Sanders | Driver | 312 Kilgo, Clayton, NC 27520 | 2020-08-17 |
| 1831701382 | Deawna Jackson | Social Worker | 205 Gracie Lane, Clayton, NC 27520 | 2020-08-17 |
| 1952947798 | Mac Partners LLC | Home Health | 10027 Hwy 70 Business, Suite B, Clayton, NC 27520 | 2019-11-26 |
| 1386291102 | Benjamin R Anderson | Physician Assistant | 2138 Nc 42, Clayton, NC 27520 | 2019-08-26 |
| 1396217923 | Lindsey R. Williams Dds, Pa | Dentist | 45 Shotwell Rd., Clayton, NC 27520 | 2018-12-20 |
| 1063987303 | Christopher James Lane | Physician Assistant | 2076 Nc 42 W, Suite 230, Clayton, NC 27520 | 2018-10-12 |
| 1245733971 | Cordelia O Emebo | Pharmacist | 11360 Old Us Hwy 70 West, Clayton, NC 27520 | 2018-03-08 |
| 1487166906 | Kendall Bonot Rodgers | Physician Assistant | 11491 Us 70 Bus Hwy W, Clayton, NC 27520 | 2017-10-25 |
| 1033620828 | Laura Nguyen | Physician Assistant | 2076 Nc-42, Suite 230, Clayton, NC 27520 | 2017-10-19 |
| 1467974394 | Liliana Galvan | Social Worker | 510 W Main St., Suit 100, Clayton, NC 27520 | 2017-07-12 |
| Find all providers in zip 27520 | ||||
| Taxonomy Code | 2080P0214X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Pulmonology |
| A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023519543 | Julie Renee Kerth | Pediatrics | Wake Forest Baptist Medical Center 1, Winston Salem, NC 27157-0001 | 2018-02-21 |
| 1649455072 | Timothy John Vece | Pediatrics | 450 Macnider, Cb # 7217, 333 S. Columbia St, Chapel Hill, NC 27599-7217 | 2008-01-03 |
| 1174531602 | Steven M Julius | Pediatrics | 11 Vanderbilt Parkway, Asheville, NC 28803 | 2006-08-03 |
| 1669032231 | Novant Medical Group, Inc. | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8286 | 2019-06-17 |
| 1295392322 | Novant Medical Group Inc | Pediatrics | 5370 Ridge Rd, Charlotte, NC 28269-2298 | 2019-05-23 |
| 1225531445 | Novant Medical Group, Inc. | Pediatrics | 1401 Matthews Township Pkwy Ste 100, Matthews, NC 28105-5403 | 2018-03-14 |
| 1417477977 | Novant Medical Group, Inc | Pediatrics | 201 Queens Rd, Charlotte, NC 28204-3217 | 2017-06-26 |
| 1821475468 | Pallav Halani | Pediatrics | 333 S Columbia St, Chapel Hill, NC 27599 | 2015-05-04 |
| 1144624206 | Carolinas Physicians Network Inc | Pediatrics | 929 N 2nd St, Ste 205, Albemarle, NC 28001-3363 | 2014-10-20 |
| 1962839068 | The Charlotte-mecklenburg Hospital Authority | Pediatrics | 9625 Northcross Center Ct, Ste 102d, Huntersville, NC 28078-7348 | 2013-10-03 |
| Find all providers with the same taxonomy | ||||
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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.