PRIVATE DIAGNOSTIC CLINIC, PLLC (NPI# 1932125432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932125432 |
| Entity Type | Organization |
| Organization Name | PRIVATE DIAGNOSTIC CLINIC, PLLC |
| Other Organization Name | UNIVERSITY ORTHOPAEDICS AND SPORTS MEDICINE |
| Practice Address |
507 N Brightleaf Blvd Suite 100 Smithfield NC 27577-4405 |
| Mailing Address |
Po Box 63362 Charlotte NC 28263-3362 |
| Practice Telephone | 9199896535 |
| 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 | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89011TW | 05 | |
| NC | BCBS GRP | 011TW | 01 |
| Other Name | Type Code |
|---|---|
| University Orthopaedics and Sports Medicine | 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 |
507 N BRIGHTLEAF BLVD SUITE 100 |
| City | SMITHFIELD |
| State | NC |
| Zip Code | 27577-4405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659304848 | Private Diagnostic Clinic, Pllc | Internal Medicine | 507 N Brightleaf Blvd, Suite 100, Smithfield, NC 27577-4405 | 2006-07-09 |
| 1528404415 | Johnston Specialty Physician Services, Inc. | Neuromusculoskeletal Medicine & OMM | 507 N Brightleaf Blvd, Suite 100, Smithfield, NC 27577-4405 | 2013-05-17 |
| 1649411505 | William Hawkins | Physician Assistant | 507 N Brightleaf Blvd, Suite 100, Smithfield, NC 27577-4405 | 2009-03-23 |
| 1720224157 | Amanda Jo-lynne Pollard | Physician Assistant | 507 N Brightleaf Blvd, Suite 209, Smithfield, NC 27577-4405 | 2009-01-07 |
| 1235304825 | James Alexis Macdonald Jr. | Psychiatry & Neurology | 507 N Brightleaf Blvd, Suite 100, Smithfield, NC 27577-4405 | 2008-04-24 |
| 1407039324 | Tri County Community Health Council Inc | Clinic/Center | 507 N Brightleaf Blvd, Suite 209, Smithfield, NC 27577-4405 | 2007-12-13 |
| 1184815581 | Johnston Memorial Hospital Authority | Internal Medicine | 507 N Brightleaf Blvd, Suite 201 Medical Arts Bldg, Smithfield, NC 27577-4405 | 2007-08-09 |
| 1447478771 | Mohamed & Associates Urology Center, Pa | Registered Nurse | 507 N Brightleaf Blvd, Suite 205, Smithfield, NC 27577-4405 | 2007-04-23 |
| 1194869537 | Robert G Lippitt | Urology | 507 N Brightleaf Blvd, Suite 205, Smithfield, NC 27577-4405 | 2007-02-19 |
| 1750425195 | Adel W Mohamed | Urology | 507 N Brightleaf Blvd, Suite 205, Smithfield, NC 27577 | 2007-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851919047 | Sherwin Cuaresma Bernardino | Physical Therapist | Meadowview Assisted Living Center, 250 Nc-210, Smithfield, NC 27577 | 2020-07-14 |
| 1386297299 | Johnston Opco, LLC | Non-emergency Medical Transport (VAN) | 200 Kellie Dr, Smithfield, NC 27577 | 2019-07-19 |
| 1790255362 | Adrian Brook Taylor | Physical Therapist | 540 North Street, Smithfield, NC 27577 | 2018-11-27 |
| 1497260608 | Providence Healthcare of The Carolinas | Assisted Living Facility | 4302 Hwy Nc 210, Smithfield, NC 27577 | 2017-12-11 |
| 1720593908 | Latorya Delois Moore | Nurse Practitioner | 514 N Brightleaf Blvd Ste 1100, Smithfield, NC 27577 | 2017-12-09 |
| 1124546171 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 104 N Brightleaf Blvd, Smithfield, NC 27577 | 2017-08-30 |
| 1316482201 | Providence Pain, Spine & Recovery, Pllc | Anesthesiology | 7 Berkshire Rd, Smithfield, NC 27577 | 2016-12-30 |
| 1407203318 | Linda Pearl Trujillo | Early Intervention Provider Agency | 623 Tralee Dr, Smithfield, NC 27577 | 2016-05-20 |
| 1336500206 | Saundra Casey | Counselor | 15 Noble Street, Smithfield, NC 27577 | 2016-03-18 |
| 1639537707 | Ralph Edwin Wilson Jr. | Physician Assistant | 100 Kellie Drive, Smithfield, NC 27577 | 2016-02-04 |
| Find all providers in zip 27577 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902241805 | Ian Al'khafaji | Orthopaedic Surgery | 2719 Reynolda Rd, Winston Salem, NC 27106 | 2013-05-06 |
| 1821354812 | Sunny Patel | Orthopaedic Surgery | 1234 Huffman Mill Rd Dept Of, Burlington, NC 27215 | 2012-04-04 |
| 1174763981 | Brett Andrew Fritsch | Orthopaedic Surgery | Duke Sports Medicine Ctr, 300 Frank Bassett Drive, Durham, NC 27710-0001 | 2009-03-06 |
| 1033366885 | Scotland Orthopedics, Pa | Orthopaedic Surgery | 410 D South Jones Street, Pembroke, NC 28372 | 2008-08-23 |
| 1437315165 | North Carolina Shoulder and Elbow Surgery and Sports Medicine | Orthopaedic Surgery | 900 North Howe St, Southport, NC 28461 | 2008-08-01 |
| 1750542411 | Abby B. Maxwell | Orthopaedic Surgery | 3 Mcdowell St, Suite B, Asheville, NC 28801-4103 | 2008-06-24 |
| 1518130418 | Jeffrey Tweed Spang | Orthopaedic Surgery | University of North Carolina Hospital, Cb# 7055, Chapel Hill, NC 27599-7055 | 2008-04-11 |
| 1184746810 | Kevin Leo Krasinski | Orthopaedic Surgery | 1236 Huffman Mill Rd Ste 1300, Burlington, NC 27215-8700 | 2007-04-04 |
| 1285748970 | Statesville Hma Physician Management, Inc | Orthopaedic Surgery | 340 Signal Hill Dr, Suite A, Statesville, NC 28625-4357 | 2006-08-18 |
| 1467461566 | Timothy Ned Taft | Orthopaedic Surgery | 3154 Bioinformatics Bldg, Cb # 7055 Unc, Chapel Hill, NC 27599-0001 | 2006-08-07 |
| Find all providers with the same taxonomy | ||||
| City | SMITHFIELD |
| Zip Code | 27577 |
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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.