Individual provider Active NPI

Amy Holmes Mendez, MPH, RD, LD

  • Registered Dietitian
  • Arvada, CO
National Provider Identifier
1023268877
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
189 Issued in SC
Practice address
16857 W 87TH Ave
Arvada, CO 80007-6754
Phone
(843) 509-4696
NPI assigned
Sep 29, 2008
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 189 SC Primary

Addresses

Primary practice location

16857 W 87TH Ave
Arvada, CO 80007-6754

Mailing address

16857 W 87TH Ave
Arvada, CO 80007-6754
Phone (843) 509-4696

Other identifiers 1

IdentifierTypeStateIssuer
DT1024MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231012003685 CO Practitioner - Registered Dietitian Or Nutrition Professional 4082772330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nutrition DynamixGroup PAC ID 3870908916, 3 clinicians

Practice addresses (Care Compare)

825 Delaware Ave
Suite 200
Longmont, CO 80501-6169
Phone (720) 252-9415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
189SCMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Nutrition Dynamix, LLC CurrentSince Sep 18, 2023 Accepting new patients

Locations

825 Delaware Ave
Ste 200
Longmont, CO 80501
Phone (720) 252-9415

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1023268877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16857 W 87TH AVE",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800076754",
            "telephone_number": "843-509-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16857 W 87TH AVE",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800076754",
            "telephone_number": "843-509-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "AMY",
        "middle_name": "HOLMES",
        "name_prefix": "Mrs.",
        "credential": "MPH, RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "SC",
            "license": "189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DT1024",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arvada, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.