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WAKE SKIN CANCER CENTER, PA
NPI 1497211189
Dermatology - MOHS-Micrographic Surgery in Wake Forest, NC

Active since February 18, 2019CLIA Certified · 2 labs
11640 NORTHPARK DR STE 200, WAKE FOREST, NC 27587(919) 436-4124 Get Directions Write a Review

NPPES record last updated: August 6, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 6, 2024, Feb 18, 2019 (2 updates tracked since 2019).

About Wake Skin Cancer Center, Pa NPPES

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

WAKE SKIN CANCER CENTER, PA (NPI 1497211189) is a healthcare organization registered as a mohs-micrographic surgery in Wake Forest, North Carolina and active in the NPI registry since February 2019. The organization holds 2 active CLIA laboratory certificates and lists Elias Emile Ayli, President, as its authorized official.

NPPES Registry Identity

NPI1497211189
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameWAKE SKIN CANCER CENTER, PA
Location Address11640 NORTHPARK DR STE 200Wake Forest, NC 27587-5741
Mailing Address11640 Northpark Dr Ste 200Wake Forest, NC 27587-5741 · (919) 436-4124
Phone(919) 436-4124
Organization SubpartNo
Authorized OfficialElias Emile AyliPresident · (919) 436-4124
Enumeration DateFebruary 18, 2019
Last NPPES UpdateAugust 6, 20242 updates tracked since enumeration
NPPES CertifiedAugust 6, 2024
✔ NPI 1497211189 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
11640 NORTHPARK DR STE 200, Wake Forest, NC 27587
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wake Skin Cancer Center, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Wake Skin Cancer Center, PA, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Elias Ayli, D.O.
Dermatology
NPI 1376706101
11640 NORTHPARK DR STE 200
Wake Forest, NC 27587
(919) 436-4124
✔ PECOS✔ Accepts MedicareSame address
Edward Galiczynski, DO
Dermatology
NPI 1255517041
11640 NORTHPARK DR STE 200
Wake Forest, NC 27587
(919) 436-4124
✔ PECOS✔ Accepts MedicareSame address
Lauren Kramer, NP
Nurse Practitioner
NPI 1295414563
11640 NORTHPARK DR STE 200
Wake Forest, NC 27587
(919) 307-9461
✔ PECOS✔ Accepts MedicareSame address
Osward Carrasquillo Gonzalez, MD, MPH
Dermatology
NPI 1336535855
410 MARKET ST STE 400
Chapel Hill, NC 27516
(984) 974-3839
✔ PECOS✔ Accepts Medicare30 mi

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

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2329041

Wake Skin Cancer Center PA · Clayton, NC
Active · expires Aug 20, 2027
CLIA Number34D2329041
Laboratory TypePhysician Office
Certificate Effective DateAugust 21, 2025
Certificate Expiration DateAugust 20, 2027
Laboratory DirectorElias E. Ayli
Laboratory Phone(919) 436-4124
Laboratory LocationWake Skin Cancer Center PA166 Springbrook Ave Suite 203, Clayton, NC 27527
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 34D2168553

Wake Skin Cancer Center · Wake Forest, NC
Active · expires Aug 10, 2027
CLIA Number34D2168553
Laboratory TypePhysician Office
Certificate Effective DateAugust 11, 2025
Certificate Expiration DateAugust 10, 2027
Laboratory DirectorElias E. Ayli
Laboratory Phone(919) 436-4124
Laboratory LocationWake Skin Cancer Center11640 North Park Dr - Suite 200, Wake Forest, NC 27587
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Wake Skin Cancer Center, PA's NPI number?

The NPI number for Wake Skin Cancer Center, PA is 1497211189. It was assigned to this organization in the NPPES registry on February 18, 2019.

Where is Wake Skin Cancer Center, PA located?

Wake Skin Cancer Center, PA is located at 11640 Northpark Dr Ste 200, Wake Forest, NC 27587. The listed phone number is (919) 436-4124.

What is Wake Skin Cancer Center, PA's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Wake Skin Cancer Center, PA enrolled in Medicare?

Yes. Wake Skin Cancer Center, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wake Skin Cancer Center, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Wake Skin Cancer Center, PA. A 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 the clinician's services. The largest specialties are Dermatology (3) and Nurse Practitioner (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Wake Skin Cancer Center, PA hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Wake Skin Cancer Center, PA accept?

Health plans from Blue Cross and Blue Shield of NC list Wake Skin Cancer Center, PA 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.

When was this NPI record last updated?

The NPPES record for Wake Skin Cancer Center, PA was last updated on August 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.