NPIMap

Organization Active NPI

Dynamic Prosthetic & Orthotic, LLC

Doing business as Prosthetic And Orthotic Associates of Tennessee

  • Prosthetic/Orthotic Supplier
  • Chattanooga, TN
National Provider Identifier
1669655999
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
DYNAMIC PROSTHETIC & ORTHOTIC, LLC
Doing business as
Prosthetic And Orthotic Associates of Tennessee
Practice address
2116 McCallie Ave
Chattanooga, TN 37404-3118
Phone
(423) 622-2000
Fax
(423) 622-2400
NPI assigned
Dec 10, 2007
Last updated
May 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Authorized official

Name
Andrew Chao
Title
Vice President
Phone
(423) 622-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2116 McCallie Ave
Chattanooga, TN 37404-3118

Mailing address

2116 McCallie Ave
Chattanooga, TN 37404-3118
Phone (423) 622-2000

Other identifiers 3

IdentifierTypeStateIssuer
1454227MedicaidTN
000951684AMedicaidGA
4033710OtherTNBLUECARE/BLUECROSS

Other names 1

  • Prosthetic And Orthotic Associates of Tennessee Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930054957 TN DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 5496965782 Practice locations: Chattanooga, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Dynamic Prosthetic & Orthotic, LLC2116 McCallie Ave, Chattanooga, TN 37404-3118(423) 622-2000 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Mar 16, 2005

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 10

Organizations listed as members of this organization in the National Provider Directory.

Locations

2116 McCallie Ave
Chattanooga, TN 37404
Phone (423) 622-2000

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1669655999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 MCCALLIE AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043118",
            "telephone_number": "423-622-2000",
            "fax_number": "423-622-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 MCCALLIE AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043118",
            "telephone_number": "423-622-2000",
            "fax_number": "423-622-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PROSTHETIC & ORTHOTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "CHAO",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "423-622-2000"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1454227",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000951684A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE/BLUECROSS",
            "identifier": "4033710",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prosthetic And Orthotic Associates of Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.