PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1538410386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538410386 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | CAROLINA FAMILY PRACTICE & SPORTS MEDICINE-RALEIGH |
| Practice Address |
8300 Health Park Ste. 107 Raleigh NC 27615-4730 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9192382000 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |
| Authorized Official Name | VALLA F WILSON (CHIEF COMPLIANCE PRIVACY & AUDIT OF) |
| Authorized Official Telephone | 9196685161 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Carolina Family Practice & Sports Medicine-Raleigh | 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 |
8300 HEALTH PARK STE. 107 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27615-4730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053396705 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 8300 Health Park, Ste 223, Raleigh, NC 27615-4730 | 2005-12-14 |
| 1730533662 | Ann Marie Dougherty | Dietitian, Registered | 8300 Health Park, Ste 325, Raleigh, NC 27615-4730 | 2016-04-18 |
| 1972967628 | Triangle Orthopaedic Associates, Pa | Durable Medical Equipment & Medical Supplies | 8300 Health Park, Suite 109, Raleigh, NC 27615-4730 | 2016-04-08 |
| 1447610134 | Vidhya Bhat | Specialist/Technologist | 8300 Health Park, Suite 107, Raleigh, NC 27615-4730 | 2016-02-24 |
| 1639552631 | Brittany Kay Torres | Physical Therapist | 8300 Health Park, Suite 127, Raleigh, NC 27615-4730 | 2015-07-08 |
| 1760884605 | William Stanley Renkas | Physical Therapist | 8300 Health Park, Suite 127, Raleigh, NC 27615-4730 | 2014-09-23 |
| 1639588288 | Matthew Wertman | Physical Therapist | 8300 Health Park, Suite 127, Raleigh, NC 27615-4730 | 2014-08-07 |
| 1003228081 | Courtney Fletcher | Physical Therapist | 8300 Health Park, Suite 127, Raleigh, NC 27615-4730 | 2014-05-27 |
| 1407279243 | Jessica Goff | Dietitian, Registered | 8300 Health Park, Ste 325, Raleigh, NC 27615-4730 | 2014-01-30 |
| 1508287822 | Child and Family Psychiatry Pllc | Psychiatry & Neurology | 8300 Health Park, 201, Raleigh, NC 27615-4730 | 2014-01-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588278535 | Emily Grace Johnson | Behavior Technician | 119 Wind Chime Court, Suite 4, Raleigh, NC 27615 | 2020-09-06 |
| 1730706110 | Maja V Martin, Dds, Pa1 | Clinic/Center | 7371 Six Forks Road, Raleigh, NC 27615 | 2020-07-01 |
| 1972146967 | Atlantic Avenue Pharmaceutical, Inc | Pharmacy | 5621 Atlantic Ave, Suite 103, Raleigh, NC 27615 | 2019-10-22 |
| 1023503950 | Siyara Shannay Dobbs | Social Worker | 7013 Woodbend Dr Apt H, Raleigh, NC 27615 | 2018-06-23 |
| 1194210153 | Brittanie Ja'nell Harris | Dentist | 1911 Falls Valley Dr Ste 107, Raleigh, NC 27615 | 2018-06-22 |
| 1710489448 | Sherise Swensen | Social Worker | 8368 Six Forks Road, Suite 101, Raleigh, NC 27615 | 2018-03-08 |
| 1881100345 | Casey Paul Baine | Counselor | 6330 Falls of Neuse Rd Ste 104, Raleigh, NC 27615 | 2017-12-20 |
| 1588177885 | Michael Lacidonia | Acupuncturist | 6400 Falls of Neuse Rd Ste 200, Raleigh, NC 27615 | 2017-11-08 |
| 1457877631 | Matt Henderson | Behavioral Analyst | 8374 Six Forks Road, Suite 101, Raleigh, NC 27615 | 2017-08-18 |
| 1760907646 | Shakeda Muldrow | Social Worker | 7323 Brookbank Lane, Raleigh, NC 27615 | 2017-08-11 |
| Find all providers in zip 27615 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://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 Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720051154 | Richard D Adelman Md | Family Medicine | 7320 Six Forks Rd, Ste 260, Raleigh, NC 27615 | 2006-02-08 |
| 1508008574 | Matthew G Kanaan | Family Medicine | 3100 Blue Ridge Rd, Raleigh, NC 27612-8036 | 2009-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255825410 | Novant Medical Group Inc. | Family Medicine | 15033 Balloncroft Parkway, Suite 200, Charlotte, NC 28277 | 2018-06-20 |
| 1760831028 | William M Sykes | Family Medicine | 129 T.t. Lanier St., Buies Creek, NC 27506 | 2016-06-08 |
| 1730561655 | Brendan Jay Michel | Family Medicine | 437 Little Fisher Trl, Mount Airy, NC 27030-6900 | 2015-06-27 |
| 1699179804 | Carolinas Physicians Network Inc | Family Medicine | 48380 Us Highway 52 N, Misenheimer, NC 28109 | 2014-10-17 |
| 1548509805 | Carolinas Physician Network, Inc. | Family Medicine | 332 North Trade Street, Suite 1200, Matthews, NC 28105-6566 | 2013-02-06 |
| 1699903211 | Robert Alcott | Family Medicine | 6050 W Highway 74, Ste D, Indian Trail, NC 28079-3591 | 2009-06-23 |
| 1962637926 | Thomas Joseph Thekkekandam | Family Medicine | 1635 Nc Highway 66 S, Suite 210, Kernersville, NC 27284-3854 | 2009-05-20 |
| 1477738714 | Forsyth Medical Group, LLC. | Family Medicine | 1900 S Hawthorne Rd Ste 480, Dba Sports Medicine Associates, Winston Salem, NC 27103-3913 | 2008-01-07 |
| 1396938171 | Lawrence M Linett, Md, Pllc | Family Medicine | 431 Western Blvd Ste E, Jacksonville, NC 28546-6823 | 2007-08-24 |
| 1962536516 | Richard T. Ferro | Family Medicine | 6832 Market St, Suite A, Wilmington, NC 28405-9723 | 2007-03-15 |
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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.