DYLAN BOYD SODERSTRUM (MD) – Emergency Medicine Physician, NPI 1720664188

DYLAN BOYD SODERSTRUM (MD) is a healthcare provider. based in Charlottesville, Virginia. specializing in EMERGENCY MEDICINE. They hold the professional credentials MD. They hold a License No. 341002 (LA). The NPI Number for DYLAN BOYD SODERSTRUM (MD) is 1720664188

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
DYLAN BOYD SODERSTRUM (MD)
NPI
1720664188
Phone
(434) 924-8485
Address
1215 LEE ST
Enumeration Date
24 March 2021
Last Update Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9857306700
Graduation Year
2021 (5 years ago)
PAC ID
7315348414
Group Practice PAC ID
4284928094
Professional Enrollment ID
I20240930001792
Address ID
LA704273729BO433XXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:5State licenses:1Digital endpointsOther names

1,497 EMERGENCY MEDICINE in VA

Provider Addresses for DYLAN BOYD SODERSTRUM (MD)

  • 1215 LEE ST

    CHARLOTTESVILLE, VA 229080816

    Phone: (434) 924-8485

    Fax: (434) 982-4118

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240930001792IEmergency MedicineLATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 22908)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4284928094View full group profile

Reviews

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Frequently asked questions

How do payers reference DYLAN BOYD SODERSTRUM (MD)?
For DYLAN BOYD SODERSTRUM (MD), use NPI 1720664188 as the unique 10-digit identifier.
Is DYLAN BOYD SODERSTRUM (MD) shown as active in public data?
Registry records indicate DYLAN BOYD SODERSTRUM (MD) maintains an active NPI.
What area of care is associated with DYLAN BOYD SODERSTRUM (MD)?
DYLAN BOYD SODERSTRUM (MD)'s record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is DYLAN BOYD SODERSTRUM (MD) associated with Charlottesville?
Public fields place DYLAN BOYD SODERSTRUM (MD) around Charlottesville, Virginia. Always confirm the exact site before visiting.
Can I trust this NPI listing for DYLAN BOYD SODERSTRUM (MD)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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