NPIMap

Organization Active NPI

Dynamic Health Carolinas, PLLC

  • General Practice Physician
  • Charlotte, NC
National Provider Identifier
1124693338
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DYNAMIC HEALTH CAROLINAS, PLLC
Practice address
4705 South Blvd.
Charlotte, NC 28217-2771
Phone
(704) 525-6288
Fax
(704) 525-6384
NPI assigned
May 21, 2021
Last updated
May 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Dixie Winslow
Title
Executive Assistant
Phone
(704) 525-6288

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X

Addresses

Primary practice location

4705 South Blvd.
Charlotte, NC 28217-2771

Mailing address

4705 South Blvd.
Charlotte, NC 28217-2771
Phone (704) 525-6288

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address staff@dynamichealthcarolinas.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210608002993 NC Part B Supplier - Clinic/Group Practice 9537569868 Receives reassigned benefits from 3 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1124693338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 SOUTH BLVD.",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172771",
            "telephone_number": "704-525-6288",
            "fax_number": "704-525-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 SOUTH BLVD.",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172771",
            "telephone_number": "704-525-6288",
            "fax_number": "704-525-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC HEALTH CAROLINAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "WINSLOW",
        "authorized_official_first_name": "DIXIE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "704-525-6288"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "staff@dynamichealthcarolinas.com",
            "affiliation": "N",
            "address_1": "4705 South Blvd.",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282172771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.