NPIMap

Individual provider Active NPI

Dino Peter Kanelos, M.D.

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1306959705
Registry record updated Oct 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9801330 Issued in NC
Practice address
11220 Elm LN
Suite 102
Charlotte, NC 28277-0715
Phone
(704) 847-4000
Fax
(704) 847-4001
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9801330 NC Primary

Addresses

Primary practice location

11220 Elm LN
Suite 102
Charlotte, NC 28277-0715

Mailing address

11220 Elm LN
Suite 102
Charlotte, NC 28277-0715
Phone (704) 847-4000

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
I20040511001096 NC Practitioner - Family Practice 5092627620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 1997
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Carolina Family Healthcare, PAGroup PAC ID 3577546662, 6 clinicians
Comprehab, IncGroup PAC ID 2769653757, 376 clinicians

Practice addresses (Care Compare)

11220 Elm LN
Charlotte, NC 28277-0716

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Charlotte, NC, CCN 347091
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9801330NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Healthcare, PA Family Medicine CurrentSince Oct 1, 2001 Accepting new patients
Carolina Family Healthcare, PA PastSince Jan 1, 1990 Accepting new patients
Carolina Family Healthcare PastSince Jan 1, 1990 Accepting new patients

Locations

11220 Elm Ln
Ste 102
Charlotte, NC 28277
Phone (704) 847-4000

1932 Weddington Rd
Weddington, NC 28104
Phone (704) 847-4000

Interoperability endpoints

  • Direct secure messaging: dino.kanelos.1@4412.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382486400000",
    "number": "1306959705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11220 ELM LN",
            "address_2": "SUITE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282770715",
            "telephone_number": "704-847-4000",
            "fax_number": "704-847-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11220 ELM LN",
            "address_2": "SUITE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282770715",
            "telephone_number": "704-847-4000",
            "fax_number": "704-847-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANELOS",
        "first_name": "DINO",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9801330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.