PRODIGY HEALTH AND WELLNESS PLLC
NPI 1740061886
Nurse Practitioner - Primary Care in Raleigh, NC
About Prodigy Health And Wellness Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRODIGY HEALTH AND WELLNESS PLLC (NPI 1740061886), doing business as Prodigy Health & Wellness Pllc, is a healthcare organization registered as a primary care in Raleigh, North Carolina and active in the NPI registry since October 2023. The organization holds a CLIA Waiver certificate valid through October 23, 2027 and lists Lisa P. Blevins, Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Prodigy Health And Wellness Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Prodigy Health And Wellness PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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
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 34D2292347
Prodigy Health And Wellness, PLLC · Raleigh, NCFrequently 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 Prodigy Health And Wellness PLLC's NPI number?
The NPI number for Prodigy Health And Wellness PLLC is 1740061886. It was assigned to this organization in the NPPES registry on October 12, 2023. The provider is doing business as Prodigy Health & Wellness PLLC.
Where is Prodigy Health And Wellness PLLC located?
Prodigy Health And Wellness PLLC is located at 4000 Wake Forest Rd, Raleigh, NC 27609. The listed phone number is (919) 793-6483.
What is Prodigy Health And Wellness PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Prodigy Health And Wellness PLLC enrolled in Medicare?
Yes. Prodigy Health And Wellness PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Prodigy Health And Wellness PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Prodigy Health And Wellness PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Prodigy Health And Wellness PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2292347) is associated with this NPI, valid through October 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Prodigy Health And Wellness PLLC was last updated on October 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Prodigy Health And Wellness Pllc · NPI 1740061886
Primary Care organization in Raleigh, North Carolina. Organization record, active in the CMS NPPES registry since October 12, 2023.
## Identity
- **NPI:** 1740061886 (Entity type: Organization)
- **Enumerated:** October 12, 2023
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Also known as:** Prodigy Health & Wellness PLLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Lisa Blevins, NURSE PRACTITIONER
## Practice location
- **Address:** 4000 WAKE FOREST RD, Raleigh, NC 27609-6879
- **Phone:** (919) 793-6483
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 12, 2023
- **Other identifiers:** Other 5003510 (NC)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1740061886) · Data from the CMS NPPES public registry.