MEDICARE: NORTH CAROLINA MG, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RG0100X	Gastroenterology Physician
2	2084N0400X	Neurology Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	208600000X	Surgery Physician
5	208800000X	Urology Physician
6	207T00000X	Neurological Surgery Physician
7	207RC0000X	Cardiovascular Disease Physician
8	207Y00000X	Otolaryngology Physician
9	207RP1001X	Pulmonary Disease Physician
10	207RS0012X	Sleep Medicine (Internal Medicine) Physician
11	261QU0200X	Urgent Care Clinic/Center
12	207RI0200X	Infectious Disease Physician
13	231H00000X	Audiologist
14	2085R0202X	Diagnostic Radiology Physician
15	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1215741640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CAROLINA MG, LLC

Provider Business Mailing Address
First Line	:	5221 PARAMOUNT PKWY STE 220
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-5490
Country	:	US
Telephone Number	:	984-215-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-784-3100
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE, COMMUNITY PHYSICIANS
Name	:	MARIA JAYOUSSI
Credential	:
Telephone Number	:	440-476-1713

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	03/30/2026

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Directions to “NORTH CAROLINA MG, LLC ” Practice Location

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