NPIMap

Individual provider Active NPI

Lesslie Marquez Durst, P.A.-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1417093642
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-00785 Issued in NC
Practice address
15830 Ballantyne Medical Place
Suite 100
Charlotte, NC 28277
Phone
(704) 341-0090
Fax
(704) 341-0092
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-00785 NC Primary

Addresses

Primary practice location

15830 Ballantyne Medical Place
Suite 100
Charlotte, NC 28277

Mailing address

15830 Ballantyne Medical Place
Suite 100
Charlotte, NC 28277
Phone (704) 341-0090

Other names 1

  • Ms. Lesslie Marquez Durst Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatologic Surgery of the Carolinas LLC Current Accepting new patients
Charlotte Dermatopathology, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lesslie-durst@dermcarecharlotte.e-mdsdirect.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JGGEAA

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449014400000",
    "number": "1417093642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15830 BALLANTYNE MEDICAL PLACE",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-341-0090",
            "fax_number": "704-341-0092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15830 BALLANTYNE MEDICAL PLACE",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-341-0090",
            "fax_number": "704-341-0092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURST",
        "first_name": "LESSLIE",
        "middle_name": "MARQUEZ",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2015-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESSLIE",
            "last_name": "DURST",
            "middle_name": "MARQUEZ",
            "prefix": "MS.",
            "credential": "P.A.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.