PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1609892108) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609892108 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | DUKE SPECIALTY CLINIC PERSON MEMORIAL |
| Practice Address |
615 Ridge Rd Roxboro NC 27573-4629 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9196848111 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2011-12-08 |
| Authorized Official Name | MR. MARK L CANTRELL (CHIEF PRIVACY & COMPLIANCE OFFICER) |
| Authorized Official Telephone | 9196685161 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS | 02149 | 01 |
| NC | 8902149 | 05 |
| Other Name | Type Code |
|---|---|
| Duke Specialty Clinic Person Memorial | 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 |
615 RIDGE RD |
| City | ROXBORO |
| State | NC |
| Zip Code | 27573-4629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760469282 | Alesa Mcdowell Eanes | Dietitian, Registered | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2005-12-27 |
| 1912529819 | Esther Amprofi | Nurse Practitioner | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2020-05-13 |
| 1831722503 | Nadine Kundimana Minani | Physician Assistant | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2020-02-20 |
| 1932769536 | Jon Dinozzi | Nurse Practitioner | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2019-06-17 |
| 1245899616 | Angela Yvette Blackburn | Hospitalist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2019-06-10 |
| 1164086179 | Samantha Jo Hanes | Speech-Language Pathologist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2019-04-24 |
| 1053876565 | Erica Eileen Luna | Occupational Therapist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2019-02-08 |
| 1003300294 | Amy Katherine Arnette | Physical Therapist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2018-06-20 |
| 1689166332 | Krystal Speights | Speech-Language Pathologist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2018-05-30 |
| 1942725668 | Sarah Sorenson | Occupational Therapist | 615 Ridge Rd, Roxboro, NC 27573-4629 | 2017-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043786783 | Caitlin Elissa Seidler | Physician Assistant | 910 N Madison Blvd Ste B, Roxboro, NC 27573 | 2018-10-21 |
| 1467821801 | Iris W Jackola | Nurse Practitioner | 796 Doctor's Court, Roxboro, NC 27573 | 2015-09-16 |
| 1568897213 | Person County Group Homes, Inc. | Community/Behavioral Health | 607 Henry Street, Roxboro, NC 27573 | 2013-09-12 |
| 1760820336 | J-1 Consultants LLC | Psychologist | 315 Old Allensville Road, Roxboro, NC 27573 | 2013-06-05 |
| 1932445749 | Ronnie Lee Chandler | Pharmacist | 109 North Main St., Roxboro, NC 27573 | 2012-12-26 |
| 1154559581 | Roxboro Medaccess Primary Care | Clinic/Center | 3762 Durham Road, Roxboro, NC 27573 | 2009-06-24 |
| 1699922302 | Bruce Wayne Walsh | Counselor | 355 C1 S. Madison Blvd, Roxboro, NC 27573 | 2008-08-25 |
| 1033232020 | Person County Department of Social Services | Durable Medical Equipment & Medical Supplies | 355-b South Madison Blvd, Roxboro, NC 27573 | 2007-04-06 |
| 1417095886 | Thomas Jones Day Jr. | Dentist | 407 North Main St, Roxboro, NC 27573 | 2007-02-01 |
| 1578622288 | Corey Wayne Wilson | Dentist | 112 West Barden Street, Roxboro, NC 27573 | 2006-12-08 |
| Find all providers in zip 27573 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871877639 | Unc Physicians Network, LLC | Internal Medicine | 718 Ridge Rd, Roxboro, NC 27573-4508 | 2011-09-28 |
| 1396708889 | Cardiovascular Care of Northern Carolina Pa | Internal Medicine | 515 Ridge Rd, Roxboro, NC 27573-4627 | 2006-04-07 |
| 1578848206 | Dlp Person Physician Practices, LLC | Internal Medicine | 601 Ridge Rd, Roxboro, NC 27573-4629 | 2011-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124657663 | Cardiosleep Diagnostics | Internal Medicine | 1862 Old Fort Rd, Greenville, NC 27834-9373 | 2020-04-06 |
| 1619467529 | Clerio Francisco De Azevedo Filho | Internal Medicine | 10 Medicine Circle - Duke Medical Pavilion Room 1e50, Durham, NC 27710-0001 | 2018-05-16 |
| 1700385846 | The Presbyterian Hospital | Internal Medicine | 1918 Randolph Rd Ste 820, Charlotte, NC 28207-1119 | 2018-02-05 |
| 1841713187 | Wake Specialty Physicians LLC | Internal Medicine | 3000 New Bern Ave Ste 1200, Raleigh, NC 27610-1231 | 2017-07-19 |
| 1225563463 | Benjamin Mcginty Chilcutt | Internal Medicine | 300 Meadowmont Village Cir Ste 104, Chapel Hill, NC 27517-7518 | 2017-04-25 |
| 1437517182 | Regional Physicians LLC | Internal Medicine | 103 W Center St, Lexington, NC 27292 | 2016-02-09 |
| 1982069928 | Four Jewels Healthways | Internal Medicine | 320 Lillington Ave Ste 201, Charlotte, NC 28204-3189 | 2015-12-17 |
| 1932505294 | Donald Frederick Fortin | Internal Medicine | 14001 Weston Pkwy, Suite 101, Cary, NC 27513-2255 | 2014-11-14 |
| 1538564232 | Forsyth Memorial Hospital, Inc | Internal Medicine | 694 Riverside Drive, Mt. Airy, NC 27030-3117 | 2014-10-24 |
| 1710382411 | Forsyth Memorial Hospital, Inc | Internal Medicine | 7114 Villiage Medical Circle, Clemmons, NC 27012 | 2014-10-24 |
| 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.