Individual provider Active NPI

Dominic Edward Agresta, PA

  • Physician Assistant
  • Salisbury, NC
National Provider Identifier
1093962045
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-01450 Issued in NC
Practice address
340 Jake Alexander Blvd W
Ste 105
Salisbury, NC 28147-1364
Phone
(704) 403-6240
NPI assigned
Aug 21, 2008
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-01450 NC Primary

Addresses

Primary practice location

340 Jake Alexander Blvd W
Ste 105
Salisbury, NC 28147-1364

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

5717 Albemarle Rd
Charlotte, NC 28212-1634
Phone (704) 563-2150

Other practice location 2

7810 Providence Rd
Ste 102
Charlotte, NC 28226-2954
Phone (704) 543-6636

Other practice location 3

5727 Prosperity Crossing Dr
Ste 1100
Charlotte, NC 28269-2206
Phone (704) 863-9930

Other practice location 4

10210 Couloak Dr
Ste E
Charlotte, NC 28216-7679
Phone (704) 801-2000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dagresta412018@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100927001491 NC Practitioner - Physician Assistant 8729104799 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

10210 Couloak Dr
Suite E
Charlotte, NC 28216-7695
Phone (704) 801-2000

119 Market Place Ave
Suite D
Mooresville, NC 28117-9157
Phone (704) 801-9140

14214 Ballantyne Lake Rd
Charlotte, NC 28277-3373

1802 E Main St
Lincolnton, NC 28092-3915
Phone (980) 212-2610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-01450NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Apr 19, 2015 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Apr 19, 2015 Accepting new patients
Bladen Healthcare LLC Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

10210 Couloak Dr
Ste E
Charlotte, NC 28216
Phone (704) 801-2000

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150

5727 Prosperity Crossing Dr
Ste 1100
Charlotte, NC 28269
Phone (704) 863-9930

7810 Providence Rd
Ste 102
Charlotte, NC 28226
Phone (704) 393-4808

9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700

340 Jake Alexander Blvd W
Ste 105
Salisbury, NC 28147
Phone (704) 403-6240

Interoperability endpoints

  • Direct secure messaging: dagresta412018@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1093962045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 JAKE ALEXANDER BLVD W",
            "address_2": "STE 105",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471364",
            "telephone_number": "704-403-6240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5717 Albemarle Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282121634",
            "country_code": "US",
            "telephone_number": "704-563-2150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7810 Providence Rd",
            "address_2": "Ste 102",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282262954",
            "country_code": "US",
            "telephone_number": "704-543-6636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5727 Prosperity Crossing Dr",
            "address_2": "Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282692206",
            "country_code": "US",
            "telephone_number": "704-863-9930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10210 Couloak Dr",
            "address_2": "Ste E",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282167679",
            "country_code": "US",
            "telephone_number": "704-801-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGRESTA",
        "first_name": "DOMINIC",
        "middle_name": "EDWARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-21",
        "last_updated": "2024-07-15",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dagresta412018@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "340 Jake Alexander Blvd W",
            "address_2": "STE 105",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281471364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salisbury, NC

Sources for this page

Verify at the official NPI Registry.