NPIMap

Organization Active NPI

Dynamic Medical Solutions

  • Diagnostic Radiology Physician
  • Edmond, OK
National Provider Identifier
1922356310
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DYNAMIC MEDICAL SOLUTIONS
Practice address
3500 S Boulevard BLDG B
Suite 18B
Edmond, OK 73013-5486
Phone
(405) 570-9962
NPI assigned
Aug 16, 2012
Last updated
Aug 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Authorized official

Name
Mr. Alex Theodoridis
Title
President
Phone
(405) 570-9962

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 247100000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

3500 S Boulevard BLDG B
Suite 18B
Edmond, OK 73013-5486

Mailing address

3500 S Boulevard BLDG B
Suite 18B
Edmond, OK 73013-5486
Phone (405) 570-9962

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121128000057 OK Part B Supplier - Clinic/Group Practice 5395996284 Receives reassigned benefits from 3 practitioners
Practice locations: Edmond, OK
O20160420002240 MO Part B Supplier - Clinic/Group Practice 5395996284 Receives reassigned benefits from 2 practitioners
Practice locations: Kansas City, MO

National Provider Directory

National Provider Directory

Locations

3500 S Boulevard
Ste 18B
Edmond, OK 73013
Phone (405) 216-5875

Practitioners & affiliated clinicians

Practitioners 5

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": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502755200000",
    "number": "1922356310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 S BOULEVARD BLDG B",
            "address_2": "SUITE 18B",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135486",
            "telephone_number": "405-570-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S BOULEVARD BLDG B",
            "address_2": "SUITE 18B",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135486",
            "telephone_number": "405-570-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC MEDICAL SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2017-08-15",
        "status": "A",
        "authorized_official_last_name": "THEODORIDIS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-570-9962",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.