NPIMap

Organization Active NPI

Dynamic Healthcare LLC

  • Family Nurse Practitioner
  • Clovis, NM
National Provider Identifier
1093396160
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
DYNAMIC HEALTHCARE LLC
Practice address
912 W 21St St
Clovis, NM 88101-4154
Phone
(575) 935-9000
Fax
(575) 935-1002
NPI assigned
Apr 19, 2021
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Lacey MeeksNPI 1235384850
Title
NP/Owner
Phone
(806) 481-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary
Pediatric Nurse Practitioner 363LP0200X NU

Addresses

Primary practice location

912 W 21St St
Clovis, NM 88101-4154

Mailing address

912 W 21St St
Clovis, NM 88101-4154
Phone (575) 935-9000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210817004095 NM Part B Supplier - Clinic/Group Practice 0345649083 Receives reassigned benefits from 11 practitioners
Practice locations: Clovis, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2230473Dynamic Healthcare912 W 21St, Clovis, NM 88101AccreditationJan 29, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1093396160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 W 21ST ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014154",
            "telephone_number": "575-935-9000",
            "fax_number": "575-935-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 W 21ST ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881014154",
            "telephone_number": "575-935-9000",
            "fax_number": "575-935-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "MEEKS",
        "authorized_official_first_name": "LACEY",
        "authorized_official_title_or_position": "NP/OWNER",
        "authorized_official_telephone_number": "806-481-7000"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.