Andrew J Dyksterhouse, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

200300027 Issued in NC

Practice address

1220 Spruce St
Belmont, NC 28012-3370

Phone

(704) 825-5333

Fax

(704) 825-1751

NPI assigned

Apr 6, 2006

Last updated

Feb 23, 2010By 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

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of South Carolina School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caromont Medical Group IncGroup PAC ID 3577476258, 425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Caromont Health Services Inc.

  dba Courtland Terrace

  • Skilled Nursing Facility
  • Gastonia, NC
  • NPI 1073599510

  Operational/Managerial Control

  CMS ownership
• Gaston Memorial Hospital, Incorporated

  dba CaroMont Regional Medical Center

  • General Acute Care Hospital
  • Gastonia, NC
  • NPI 1013918960

  W-2 Managing Employee

  CMS ownership

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.

• Caromont Medical Group Inc

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1356314272
  Medicare reassignment Care Compare group NPD
• Caromont Medical Group Inc

  dba CaroMont Urgent Care

  • Family Medicine Physician
  • Cherryville, NC
  • NPI 1275209926
  NPD
• Caromont Medical Group Inc

  • Family Medicine Physician
  • Stanley, NC
  • NPI 1972301380
  NPD
• Caromont Medical Group Inc

  dba CaroMont Family Medicine

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1982883583
  NPD
• Caromont Medical Group Inc

  dba CaroMont Family Medicine

  • Family Medicine Physician
  • Stanley, NC
  • NPI 1245419845
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1831151596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 SPRUCE ST",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280123370",
            "telephone_number": "704-825-5333",
            "fax_number": "704-825-1751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 SPRUCE ST",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280123370",
            "telephone_number": "704-825-5333",
            "fax_number": "704-825-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTERHOUSE",
        "first_name": "ANDREW",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200300027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00393599",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89137MH",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kobie Alexander Dudley Jr.
• David Albert Duncan
• Maya Nicole Dupree
• Jerome Michael Duren, D.D.S.
• Durkin Chiropractic Center PLLC
• E&H, LLC
• Eckerd Corporation (Rite Aid Pharmacy 11432)
• Melanie Eckstein
• Jessica L Eiselt, PT
• Amal Idris Ahmed Elhaj, MD

• Family Medicine Physician in Belmont, NC
• Providers in Belmont, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; 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; Order and Referring.
• 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.