Dynamic Health Centers

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

DYNAMIC HEALTH CENTERS

Practice address

163 SW Stonegate Ter Ste 109
Lake City, FL 32024-3459

Phone

(386) 438-8391

NPI assigned

Apr 6, 2010

Organization subpart

No

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

Authorized official

Name

Melissa Distefano

Title

President

Phone

(352) 262-5625

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Dynamic Primary Healthcare Clinic

  • Family Medicine Physician
  • Lake City, FL
  • NPI 1710633144

  Sold to, 2022-06-01

  CMS change of ownership

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

{
    "created_epoch": "1270512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1508181272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 SW STONEGATE TER STE 109",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243459",
            "telephone_number": "386-438-8391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 SW STONEGATE TER STE 109",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243459",
            "telephone_number": "386-438-8391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-06",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "DISTEFANO",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-262-5625"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "HCC8936",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006309100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Dust, ARNP
• Mitchell Duterte, MD
• Lauren Dutton
• Anna J Dyal
• Gregory A Dyle, PHARM D
• Dynamic Primary Healthcare Clinic
• Earnest Emergency Physicians, LLC
• Miranda Leann Eash, APRN
• Easy to Breathe LLC
• Patricia J. Eaton

• Rural Health Clinic/Center in Lake City, FL
• Providers in Lake City, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.