NPIMap

Organization Active NPI

Dietitian Services LLC

  • Clinic/Center
  • Matthews, NC
National Provider Identifier
1982311809
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DIETITIAN SERVICES LLC
Practice address
1315 Matthews Mint Hill Rd Ste B
Matthews, NC 28105-2694
Phone
(704) 277-9059
NPI assigned
Oct 31, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Authorized official

Name
Jason Russo
Title
Owner Manager
Phone
(704) 277-9059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1315 Matthews Mint Hill Rd Ste B
Matthews, NC 28105-2694

Mailing address

12113 Landen Dr
Charlotte, NC 28277-4664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC, CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20230124001214 NC Part B Supplier - Clinic/Group Practice 6507237856 Receives reassigned benefits from 3 practitioners
Practice locations: Mint Hill, NC
O20240314003110 SC Part B Supplier - Clinic/Group Practice 6507237856 Practice locations: Okatie, SC
O20240601000352 CA Part B Supplier - Clinic/Group Practice 6507237856 Receives reassigned benefits from 1 practitioner
Practice locations: Bakersfield, CA

National Provider Directory

National Provider Directory

Locations

1315 Matthews Mint Hill Rd
Ste B
Matthews, NC 28105
Phone (704) 387-4460

4301 Morris Park Dr
#21
Mint Hill, NC 28227
Phone (704) 387-4460

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1982311809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12113 LANDEN DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 MATTHEWS MINT HILL RD STE B",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281052694",
            "telephone_number": "704-277-9059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIETITIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER MANAGER",
        "authorized_official_telephone_number": "704-277-9059"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.