NPIMap

Organization Active NPI

Dynamic Pain & Wellness PLLC

  • Pain Medicine Physician
  • Destin, FL
National Provider Identifier
1790228658
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
DYNAMIC PAIN & WELLNESS PLLC
Practice address
200 Calusa Blvd
Destin, FL 32541-5753
Phone
(850) 226-6801
NPI assigned
Nov 28, 2016
Last updated
Jun 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Authorized official

Name
Mathew McCune, MDNPI 1457493611
Title
Ceo
Phone
(850) 226-6801

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X NU Primary

Addresses

Primary practice location

200 Calusa Blvd
Destin, FL 32541-5753

Mailing address

200 Calusa Blvd
Suite 100
Destin, FL 32541-5753
Phone (850) 226-6801

National Provider Directory

National Provider Directory

Locations

200 Calusa Blvd
Destin, FL 32541

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1790228658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CALUSA BLVD",
            "address_2": "SUITE 100",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325415753",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CALUSA BLVD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325415753",
            "telephone_number": "850-226-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PAIN & WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "MCCUNE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-226-6801",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Destin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.