Dimple Ajay Joshi, PA-C
Individual provider Active NPI Medical Physician Assistant · Concord, NC
NPI 1407960768 · NPPES record last updated Feb 24, 2014
Key facts
- NPI
- 1407960768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 104215 (NC)
- Practice address
- 100 Medical Park Dr
Suite 210
Concord, NC 28025-2948 - Phone
- (704) 403-6100
- Fax
- (704) 403-6131
- NPI assigned
- Aug 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050404000757 | NC | Practitioner - Physician Assistant | 1951204403 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 911 | SC | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Luke'S Hospital, Inc | Current |
Accepting new patients | |
| Carolinas Physicians Network Inc | Current |
Accepting new patients | |
| Carolinas Physicians Network Inc | Current |
Accepting new patients | |
| St. Luke'S Hospital Inc. | Current |
Accepting new patients |
Locations
14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650
9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700
1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791
5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150
100 Medical Park Dr
Ste 210
Concord, NC 28025
Phone (704) 403-6100
270 Copperfield Blvd NE
Ste 102
Concord, NC 28025
Phone (704) 721-2060
990 Lee Ann Dr NE
Concord, NC 28025
Phone (704) 441-0272
1550 Faulk St
Ste 1500
Monroe, NC 28112
Phone (704) 302-9700
1347 Ozone Dr
Ste 2
Saluda, NC 28773
Phone (828) 749-0149
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/6250bb55-ad93-47a0-aec6-517b10254738/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 104215 | NC | Yes |
| Medical Physician Assistant | 363AM0700X | 911 | SC |
Addresses
Primary practice location
100 Medical Park Dr
Suite 210
Concord, NC 28025-2948
Mailing address
PO Box 602478
Charlotte, NC 28260-2478
Phone (704) 403-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407960768 | Medicaid | NC | |
| 0306PA | Medicaid | SC | |
| P00307924 | Other | RAILROAD MEDICARE |
Other providers in Concord, NC
- Janaesea' Jordan
- Mary Margaret Holloman Jordan
- Sabra Jordan
- Tieshia Shadia Jordan
- Folashade Adebii Jose
- Jessica Joy
- Felisha Joyner
- Laura Herman Julian
- Seung Soo Jung
- Deepa Patel Juthani
All providers in Concord, NC · Medical Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.