Individual provider Active NPI

Richard Dykstra

  • Emergency Medicine Physician
  • Rocky Mount, VA
National Provider Identifier
1154852432
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101267433 Issued in VA
Practice address
180 Floyd Ave
Rocky Mount, VA 24151-1318
Phone
(540) 483-5277
Fax
(540) 489-6453
NPI assigned
Mar 27, 2017
Last updated
May 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2020-02936 NC
Emergency Medicine Physician 207P00000X 0101267433 VA Primary

Addresses

Primary practice location

180 Floyd Ave
Rocky Mount, VA 24151-1318

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5352

Other practice location 1

1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 832-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200626000330 NC Practitioner - Emergency Medicine 9739452384 Reassigns benefits to 1 organization
I20230620003002 VA Practitioner - Emergency Medicine 9739452384 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Wake Forest University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

180 Floyd Ave
Rocky Mount, VA 24151-1318
Phone (540) 483-5277

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101267433VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Jul 30, 2023 Accepting new patients
Carilion Giles Community Hospital CurrentSince Jul 30, 2023 Accepting new patients
Wake Forest Emergency Providers CurrentSince Jul 1, 2020 Accepting new patients
Carilion Giles Community Hospital CurrentSince Jul 30, 2023 Accepting new patients
Carilion Medical Center Emergency Medicine CurrentSince Jul 30, 2023 Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

180 Floyd Ave
Rocky Mount, VA 24151
Phone (540) 483-5277

Interoperability endpoints

  • Direct secure messaging: rdykstra90739@direct.carilionclinic.org

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 2

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": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1154852432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 FLOYD AVE",
            "city": "ROCKY MOUNT",
            "state": "VA",
            "postal_code": "241511318",
            "telephone_number": "540-483-5277",
            "fax_number": "540-489-6453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N Elm St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011004",
            "country_code": "US",
            "telephone_number": "336-832-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "RICHARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2020-02936",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101267433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, VA

Sources for this page

Verify at the official NPI Registry.