PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1861741233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861741233 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | CAROLINA FAMILY PRACTICE & SPORTS MEDICINE-HOLLY SPRINGS |
| Practice Address |
190 Rosewood Centre Dr Ste. 100 Holly Springs NC 27540-7628 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9192382000 |
| Mailing Telephone | 9196848111 |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2012-08-31 |
| 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-Holly Springs | 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 |
190 ROSEWOOD CENTRE DR STE. 100 |
| City | HOLLY SPRINGS |
| State | NC |
| Zip Code | 27540-7628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700813466 | Meredith Duckworth Taylor | Dentist | 190 Rosewood Centre Dr, Suite #200, Holly Springs, NC 27540-9451 | 2006-06-27 |
| 1770901597 | Elena Alexandrovna Kramarenko | Physical Therapist | 190 Rosewood Centre Dr, Suite 101, Holly Springs, NC 27540-7628 | 2014-03-29 |
| 1346505138 | Daniel Jason Fitzgerald | Specialist/Technologist | 190 Rosewood Centre Dr, Suite 100, Holly Springs, NC 27540-7628 | 2012-07-09 |
| 1881994903 | Novant Medical Group, Inc | Family Medicine | 190 Rosewood Centre Dr, Suite 100, Holly Springs, NC 27540-7628 | 2010-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528612785 | Marina Isabel Mckeown | Speech-Language Pathologist | 1140 W Savannah Ridge Rd, Suite 111, Holly Springs, NC 27540 | 2019-07-26 |
| 1912474784 | Foot and Ankle Specialists of The Mid-atlantic, LLC | Podiatrist | 1004 Werrington Drive, Suite 300, Holly Springs, NC 27540 | 2018-10-30 |
| 1699240937 | Kristen Shrum | Family Medicine | 401 Irving Parkway, Holly Springs, NC 27540 | 2018-10-12 |
| 1508369109 | Shannon Silsby | Nurse Practitioner | 1004 Werrington Dr Ste 200, Holly Springs, NC 27540 | 2018-03-10 |
| 1790212306 | Alex Nolan | Speech-Language Pathologist | 251 Center Street, Holly Springs, NC 27540 | 2017-05-12 |
| 1386190957 | Holly Springs Surgery Center, LLC | Clinic/Center | 600 Village Walk Drive, Holly Springs, NC 27540 | 2016-09-01 |
| 1568827723 | Leslie Clark Lively | Speech-Language Pathologist | 1140 W. Savannah Ridge Road, Suite 111, Holly Springs, NC 27540 | 2015-12-15 |
| 1124410667 | Back In Action of Holly Springs, Inc | Physical Therapist | 500 Village Walk Dr., Holly Springs, NC 27540 | 2015-02-20 |
| 1033559018 | Andrew John Krieger | Emergency Medicine | 5405 Bluet Ct, Holly Springs, NC 27540 | 2013-07-05 |
| 1598104200 | Atkins Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 144 Adrian Street, Holly Springs, NC 27540 | 2013-06-17 |
| Find all providers in zip 27540 | ||||
| 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 |
|---|---|---|---|---|
| 1417948597 | Duane Richard Hennion | Family Medicine | 401 Irving Pkwy Ste 320, Holly Springs, NC 27540-5302 | 2005-10-28 |
| 1952620429 | Matthew T Simmons | Family Medicine | 684 Sixes Rd, Suite 130, Holly Springs, GA 30115 | 2010-05-24 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | HOLLY SPRINGS |
| Zip Code | 27540 |
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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.