NPIMap

Organization Active NPI

Dynamic Health Medical Group PLLC

  • General Practice Physician
  • Charlotte, NC
National Provider Identifier
1972085918
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DYNAMIC HEALTH MEDICAL GROUP PLLC
Practice address
4705 South Blvd
Charlotte, NC 28217
Phone
(704) 525-6288
Fax
(704) 525-6384
NPI assigned
Sep 6, 2018
Last updated
Sep 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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

Authorized official

Name
Dixie Winslow
Title
Executive Assistant
Phone
(704) 525-6288

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary
Pain Medicine Physician 208VP0000X NU

Addresses

Primary practice location

4705 South Blvd
Charlotte, NC 28217

Mailing address

4705 South Blvd
Charlotte, NC 28217
Phone (704) 525-6288

Other identifiers 1

IdentifierTypeStateIssuer
0OtherNONE

National Provider Directory

National Provider Directory

Locations

4705 South Blvd
Charlotte, NC 28217
Phone (704) 525-6288

Practitioners & affiliated clinicians

Practitioners 11

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": "1536192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1972085918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 SOUTH BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28217",
            "telephone_number": "704-525-6288",
            "fax_number": "704-525-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 SOUTH BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28217",
            "telephone_number": "704-525-6288",
            "fax_number": "704-525-6384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC HEALTH MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-06",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "WINSLOW",
        "authorized_official_first_name": "DIXIE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "704-525-6288"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.