NPIMap

Individual provider Active NPI

Frederick Mast Dula Jr., MD

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1104821412
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
26625 Issued in NC
Practice address
3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117
Phone
(704) 332-1291
NPI assigned
Jun 15, 2005
Last updated
Mar 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 26625 NC Primary

Addresses

Primary practice location

3623 Latrobe Dr Ste 216
Charlotte, NC 28211-2117

Mailing address

11995 Singletree LN Ste 500
Eden Prairie, MN 55344-5349
Phone (952) 595-1301

Other practice location 1

11995 Singletree Ln Ste 500
Eden Prairie, MN 55344-5349
Phone (952) 595-1301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031230000547 NC Practitioner - Diagnostic Radiology 5991617318 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of North Carolina at Chapel Hill School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-4056

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
98.89
Improvement activities
40
Cost
72.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26625NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Oct 1, 2022 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Jan 1, 2023 Accepting new patients
Mecklenburg Radiology Associates, P.a. Diagnostic Radiology CurrentSince Jan 1, 2015 Accepting new patients
Cabarrus Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2009 Accepting new patients
Radiology Alliance PC Diagnostic Radiology CurrentSince Feb 1, 2021 Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone (704) 926-1827

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1104821412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11995 SINGLETREE LN STE 500",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445349",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR STE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112117",
            "telephone_number": "704-332-1291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11995 Singletree Ln Ste 500",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553445349",
            "country_code": "US",
            "telephone_number": "952-595-1301",
            "fax_number": "612-294-4903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DULA",
        "first_name": "FREDERICK",
        "middle_name": "MAST",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "26625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.