Dylan B Devries, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004735 Issued in GA

Practice address

110 E Routt Ave
Pueblo, CO 81004-2117

Phone

(719) 543-8711

Fax

(719) 543-0171

NPI assigned

Jan 25, 2008

Last updated

Jun 13, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Carolina Family Practice PA

  • Family Medicine Physician
  • Hertford, NC
  • NPI 1326031485
  Medicare reassignment

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

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1770760365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 E 5TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810013754",
            "telephone_number": "719-543-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVRIES",
        "first_name": "DYLAN",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-25",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desert Willow Health and Rehabilitation Center LLC (Desert Willow Health and Rehabilitation Center)
• Destiny Incorporated
• Stephen Deturk, MD
• Susan Devan
• Quinn Alyse Devinney, PHARMD.
• Bryan S Dewar, LMT
• Darcelle J Dewitt, MA, RP
• Dexter D Koons MD PC
• Hardeep Dholiya
• Diana Smith Psychiatric Mental Health Nurse Practitioner LLC (Parkview medical)

• Medical Physician Assistant in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.