Jeremy Dewolf, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06156

Practice address

645 Amalia St NE
Concord, NC 28025-2434

Phone

(704) 295-3255

Fax

(704) 295-7791

NPI assigned

Jan 6, 2016

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

Electronic endpoints 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Brody School of Medicine at East Carolina University, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charlotte Eye Ear Nose and Throat Associates PAGroup PAC ID 0446155451, 181 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001

Merit-based Incentive Payment System (MIPS)

Final score

94 of 100Reported as apm

Quality

81.63

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Charlotte Eye Ear Nose & Throat Associates, P.a.

  • Ophthalmology Physician
  • Charlotte, NC
  • NPI 1043287469

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Charlotte Eye Ear Nose & Throat Associates, PA

  • Ophthalmology Physician
  • Salisbury, NC
  • NPI 1801217948
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Charlotte-Mecklenburg Hospital Authority

  • General Acute Care Hospital
  • Concord, NC
  • NPI 1487866315
  Care Compare affiliation
• The Charlotte-Mecklenburg Hospital Authority

  • Psychiatric Hospital Unit
  • Concord, NC
  • NPI 1629283866
  Care Compare affiliation

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1972969970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 Corporate Cir",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281478074",
            "country_code": "US",
            "telephone_number": "704-637-0158",
            "fax_number": "704-637-7710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWOLF",
        "first_name": "JEREMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-06",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "0010-06156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdewolf18304@direct.ceenta.com",
            "affiliation": "N",
            "address_1": "645 Amalia St NE",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252434",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdewolf18304@direct.ceenta.com",
            "affiliation": "N",
            "address_1": "530 Corporate Cir",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281478074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cynthia Cheung Desilva, RPH
• Mary Jean Detchemendy, CRNA
• Tashana Detwiler, DMD
• Mary Elizabeth Devlin
• Tiffany Moore Dewitt, CRNA
• Diana'S Homecare, Inc
• Diana'S Homecare, Inc.
• Diana'S Homecare, Inc.
• Diana'S Homecare, Inc.
• Tagny Isabel Diaz Solis

• Physician Assistant in Concord, NC
• Providers in Concord, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.
• 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.