DYNAMIC PRIMARY HEALTHCARE CLINIC
NPI 1710633144
Family Medicine in Lake City, FL
About Dynamic Primary Healthcare Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DYNAMIC PRIMARY HEALTHCARE CLINIC (NPI 1710633144) is a healthcare organization registered as a family medicine in Lake City, Florida and active in the NPI registry since February 2022. The organization holds a CLIA Waiver certificate valid through May 18, 2028 and lists John Distefano, Business Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dynamic Primary Healthcare Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Dynamic Primary Healthcare Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2260456
Dynamic Primary Healthcare Clinic Inc · Lake City, FLFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dynamic Primary Healthcare Clinic's NPI number?
The NPI number for Dynamic Primary Healthcare Clinic is 1710633144. It was assigned to this organization in the NPPES registry on February 24, 2022.
Where is Dynamic Primary Healthcare Clinic located?
Dynamic Primary Healthcare Clinic is located at 163 SW Stonegate Ter Ste 109, Lake City, FL 32024. The listed phone number is (330) 323-8976.
What is Dynamic Primary Healthcare Clinic's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Dynamic Primary Healthcare Clinic enrolled in Medicare?
Yes. Dynamic Primary Healthcare Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Dynamic Primary Healthcare Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Dynamic Primary Healthcare Clinic. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Dynamic Primary Healthcare Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2260456) is associated with this NPI, valid through May 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Dynamic Primary Healthcare Clinic accept?
Health plans from Ambetter Health and Ambetter of Alabama list Dynamic Primary Healthcare Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Dynamic Primary Healthcare Clinic was last updated on March 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dynamic Primary Healthcare Clinic · NPI 1710633144
Family Medicine organization in Lake City, Florida. Organization record, active in the CMS NPPES registry since February 24, 2022.
## Identity
- **NPI:** 1710633144 (Entity type: Organization)
- **Enumerated:** February 24, 2022
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** John Distefano, BUSINESS MANAGER
## Practice location
- **Address:** 163 SW STONEGATE TER STE 109, Lake City, FL 32024-3459
- **Phone:** (330) 323-8976
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 18, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710633144) · Data from the CMS NPPES public registry.