Dylan Malloy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-09649 Issued in NC

Practice address

11300 Cresthill Dr Ste 120
Mint Hill, NC 28227-7924

Phone

(704) 438-9479

Fax

(704) 438-9478

NPI assigned

May 2, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmalloy766573@direct.novanthealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Charlotte, NC
  • NPI 1760950646
  Medicare reassignment Care Compare group
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Salisbury, NC
  • NPI 1053296509
  NPD
• Carolina Medicorp Enterprises, LLC

  • Urgent Care Clinic/Center
  • Asheville, NC
  • NPI 1235014796
  NPD
• Carolina Medicorp Enterprises Inc

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1417497504
  NPD (past)

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1275988990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601843",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11300 CRESTHILL DR STE 120",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282277924",
            "telephone_number": "704-438-9479",
            "fax_number": "704-438-9478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOY",
        "first_name": "DYLAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-02",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmalloy766573@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "11300 Cresthill Dr Ste 120",
            "city": "Mint Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282277924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jared Michael Little, DDS, MSD
• Robin Loker, PT
• Londry, Modlin, Tucker III DDS PLLC
• Londry, Modlin, Tucker III DDS PLLC
• Nancy Magyer, R.PH.
• Cyril Manchery, DDS
• Janet E Mangum, DMD
• Stephanie Carrie Manning, DDS
• Mateen Oliver Manshadi, MD
• Ericka Sherrell Martin

• Physician Assistant in Mint Hill, NC
• Providers in Mint Hill, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.