Dedrick Earl Moulton, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

2021-03243 Issued in NC

Practice address

1001 Blythe Blvd
Medical Center Plaza Suite 200
Charlotte, NC 28203-5866

Phone

(704) 381-8840

NPI assigned

Oct 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmoulton531711@carolinashealthcaresystem.direct-ci.com

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.

• Louisiana State University School of Med in New Orleans Faculty Grou

  dba LSU Healthcare Network

  • Pediatrics Physician
  • New Orleans, LA
  • NPI 1932492626
  Medicare reassignment NPD

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1730276841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BLYTHE BLVD",
            "address_2": "MEDICAL CENTER PLAZA SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035866",
            "telephone_number": "704-381-8840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14214 Ballantyne Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282773372",
            "country_code": "US",
            "telephone_number": "704-381-8840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Park Dr",
            "address_2": "Ste 310E",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252948",
            "country_code": "US",
            "telephone_number": "704-403-2660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1781 Tate Blvd SE",
            "address_purpose": "LOCATION",
            "city": "Hickory",
            "state": "NC",
            "postal_code": "286024251",
            "country_code": "US",
            "telephone_number": "704-381-8840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280542152",
            "country_code": "US",
            "telephone_number": "704-381-8840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "DEDRICK",
        "middle_name": "EARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-09",
        "last_updated": "2022-11-18",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2021-03243",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NC",
            "license": "2021-03243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmoulton531711@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1001 Blythe Blvd",
            "address_2": "Medical Center Plaza, Suite 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035866",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rahmana Latisa Mott, NCCPSS
• Alyssa Joy Motta, MSW, LCSW
• Victoria Grace Motta, PA-C
• Benjamin Motz, MD
• Ann Michelle Moulton, FNP
• Kelsey Elizabeth Moulton, FNP-C
• Sanita A Moulton, M.A.C.C., LMFT
• Shannell Sintell Moultrie, NP
• Mohammed Moumen, MD
• Mount Eagle Health Care-Charlotte, LLC

• Pediatric Gastroenterology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Gastroenterology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.