NPIMap

Organization Active NPI

Dynamic Wellness Center, LLC

  • Clinical Social Worker
  • Baltimore, MD
National Provider Identifier
1053881086
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
DYNAMIC WELLNESS CENTER, LLC
Practice address
4200 Edmondson Ave Ste 202
Baltimore, MD 21229-1614
Phone
(443) 499-3529
NPI assigned
Dec 3, 2018
Last updated
Dec 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

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

Authorized official

Name
Joi Dyson, LCSW-CNPI 1891023669
Title
Owner
Phone
(443) 416-8029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

4200 Edmondson Ave Ste 202
Baltimore, MD 21229-1614

Mailing address

3413 Copley Rd
Baltimore, MD 21215-7189
Phone (443) 416-8029

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191014002475 MD Part B Supplier - Clinic/Group Practice 7618208158 Receives reassigned benefits from 3 practitioners
Practice locations: Towson, MD

National Provider Directory

National Provider Directory

Locations

4200 Edmondson Ave
Ste 202
Baltimore, MD 21229
Phone (443) 416-8029

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1053881086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3413 COPLEY RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212157189",
            "telephone_number": "443-416-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 EDMONDSON AVE STE 202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291614",
            "telephone_number": "443-499-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "DYSON",
        "authorized_official_first_name": "JOI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-416-8029",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.