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DR. MARIE LUISE ZALDIVAR MD
NPI 1063472462
Family Medicine in Smithfield, NC

Active since March 28, 2006PECOS EnrolledAccepts Medicare Assignment
127 E MARKET ST, SMITHFIELD, NC 27577(919) 934-7687(919) 934-5297 Get Directions Write a Review

NPPES record last updated: February 25, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Feb 25, 2025, Mar 28, 2021 (2 updates tracked since 2021).

About Dr. Marie Luise Zaldivar Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARIE LUISE ZALDIVAR MD (NPI 1063472462) is an individual family medicine provider in Smithfield, North Carolina, licensed in North Carolina (9801124) and active in the NPI registry since March 2006. She is enrolled in Medicare PECOS, is affiliated with Unc Health Wayne, and maintains a secondary practice location in Morrisville.

NPPES Registry Identity

NPI1063472462
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. MARIE LUISE ZALDIVARCredential: MD
Location Address127 E MARKET STSmithfield, NC 27577-3915
Mailing Address208 Black Forest DrClayton, NC 27527-5314 · (919) 550-0520 · Fax (919) 550-0520
Phone(919) 934-7687
Fax(919) 934-5297
Sole ProprietorNo
Medical School CMSOtherGraduated 1988
Enumeration DateMarch 28, 2006
Last NPPES UpdateFebruary 25, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 25, 2025
✔ NPI 1063472462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in NC · 9801124
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
127 E MARKET ST, Smithfield, NC 27577
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Secondary Practice Location 1

Location 15221 Paramount Pkwy Ste 220Morrisville, NC 27560-5490 · Phone (984) 215-6641 · Fax (984) 215-4053

Other Identifiers 2

Other11623NC · Bcbs Of Nc
Medicaid8911623NC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Marie Luise Zaldivar Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5890728315
PECOS Enrollment IDI20050915000349
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Marie Zaldivar reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Unc Physicians Network, LLC
20 mi
Family Medicine
801 POOLE DR
Garner, NC 27529
  • Reassigned Medicare billing, North Carolina enrollment
  • 1,337 clinicians in this Medicare group
NPI 1154695070 (919) 779-1440

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
310 services168 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
132 services86 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
89 services89 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
75 services75 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
37 services37 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
35 services35 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Unc Health Wayne

Acute Care Hospitals · Goldsboro, NC
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number340010
Location2700 Wayne Memorial DrGoldsboro, NC 27534 · Wayne County
Emergency services Birthing friendly

Johnston Health

Acute Care Hospitals · Smithfield, NC
3/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number340090
Location509 Bright Leaf BlvdSmithfield, NC 27577 · Johnston County
Emergency services Birthing friendly

Rex Hospital

Acute Care Hospitals · Raleigh, NC
5/5 CMS rating
OwnershipGovernment - State
CMS Certification Number340114
Location4420 Lake Boone TrailRaleigh, NC 27607 · Wake County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27577 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.90 typical visit price
range $54.12 – $165.09
Typical copayment $20.97 (range $13.53 – $41.27)
Most-billed visit code 99203
Established Patient
$95.94 typical visit price
range $17.21 – $134.61
Typical copayment $23.98 (range $4.30 – $33.65)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
75%356 patients4/55-star benchmark: 92%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
99%206 patients5/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
98%3,673 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
97%3,380 patients4/55-star benchmark: 100%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
76%430 patients4/55-star benchmark: 90%
Provide Patient Access
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician…
0%1,215 patients1/55-star benchmark: 100%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 6% · 430 patients
11%430 patients2/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 7

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
11 suppliers70 claims162 services$5.73 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
9 suppliers33 claims47 services$0.95 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers14 claims14 services$35.55 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
3 suppliers12 claims12 services$51.24 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
3 suppliers15 claims86 services$1.88 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier12 claims12 services$76.06 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JESSICA STEPHENSON JOHNSON FNP
Nurse Practitioner (Family)
127 E MARKET ST
SMITHFIELD, NC 27577
Johnston County (919) 934-7687
RIVERDALE FAMILY MEDICINE, PA
Family Medicine
127 E MARKET ST
SMITHFIELD, NC 27577
Johnston County (919) 967-6646

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marie Zaldivar's NPI number?

The NPI number for Marie Zaldivar is 1063472462. It was assigned to this individual provider in the NPPES registry on March 28, 2006.

Where is Marie Zaldivar located?

Marie Zaldivar practices at 127 E Market St, Smithfield, NC 27577. The listed phone number is (919) 934-7687.

What is Marie Zaldivar's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Marie Zaldivar enrolled in Medicare?

Yes. Marie Zaldivar is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Marie Zaldivar's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Marie Zaldivar reassigns Medicare benefits to Unc Physicians Network, LLC (Garner, NC). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Marie Zaldivar's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Marie Zaldivar accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and UnitedHealthcare list Marie Zaldivar as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Marie Zaldivar affiliated with any hospitals?

According to CMS data, Marie Zaldivar is affiliated with Unc Health Wayne, Johnston Health and Rex Hospital.

When was this NPI record last updated?

The NPPES record for Marie Zaldivar was last updated on February 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.