Bishr Al Dabagh, MD
Individual provider Active NPI MOHS-Micrographic Surgery Physician · Mooresville, NC
NPI 1154565661 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1154565661
- Entity type
- Individual (NPI type 1)
- Primary specialty
- MOHS-Micrographic Surgery Physician 207ND0101X
- License
- 2019-01570 (NC)
- Practice address
- 118 Gateway Blvd Ste a
Mooresville, NC 28117-6542 - Phone
- (704) 230-1302
- NPI assigned
- Apr 28, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Micrographic Dermatologic Surgery (MDS)
- Education
- Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fora Dermatology PLLC
Bold City Dermatology LLC
Practice addresses (Care Compare)
118 Gateway Blvd
Suite a
Mooresville, NC 28117-6542
Phone (704) 230-1302
316 Paseo Reyes Dr
St Augustine, FL 32095-8464
Phone (904) 544-5800
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 164 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 505 |
| Removal of skin cancer | 864 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 212 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191101000274 | FL | Practitioner - Micrographic Dermatologic Surgery (MDS) |
9234353087 | Reassigns benefits to 1 organization |
| I20200205003135 | NC | Practitioner - Micrographic Dermatologic Surgery (MDS) |
9234353087 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD17679 | HI | MD | Dermatology Physician |
| A125540 | CA | MD | Procedural Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Darst Dermatology, PC | Dermatology | Current |
Accepting new patients |
| Bold City Dermatology LLC | Dermatology | Current |
Accepting new patients |
| Dermatology Center of Shelby PA | Dermatology | Current |
Accepting new patients |
| Brent M Boyce MD PC | Current |
Accepting new patients | |
| Fora Dermatology PLLC | Dermatology | Current |
Accepting new patients |
| Hawaiian Islands Dermatology, LLC | Dermatology | Past |
Accepting new patients |
| Charlotte Dermatopathology, Inc | Past |
Accepting new patients |
Locations
120 Gateway Cir
Unit 1
Saint Johns, FL 32259
Phone (904) 824-4407
120 Gateway Cir
Saint Johns, FL 32259
Phone (904) 544-5800
316 Paseo Reyes Dr
St Augustine, FL 32095
Phone (904) 342-0219
106 E Main St
Sebewaing, MI 48759
Phone (989) 883-3530
11301 Golf Links Dr N
Ste 203
Charlotte, NC 28277
Phone (704) 321-3376
118 Gateway Blvd
Ste A
Mooresville, NC 28117
Phone (704) 230-1302
128 Medical Park Rd
Ste 201
Mooresville, NC 28117
Phone (704) 230-1302
653 Bluefield Rd
Ste G
Mooresville, NC 28117
Phone (704) 230-1302
935 Wyke Rd
Shelby, NC 28150
Phone (704) 481-1142
1668 NC Highway 16 S
Taylorsville, NC 28681
Phone (828) 632-9736
Interoperability endpoints
- baldabagh@boldcityderm.emadirect.md
- baldabagh744299@direct.shands.ufl.edu
- baldabagh@foradermatology.emadirect.md
- https://fhir4.healow.com/fhir/r4/CJECBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301106561 | MI | |
| Dermatology Physician | 207N00000X | MD17679 | HI | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | MD17679 | HI | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | ME142263 | FL | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 4301106561 | MI | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 49483 | AZ | |
| Procedural Dermatology Physician | 207NS0135X | A125540 | CA | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 2019-01570 | NC | Yes |
Addresses
Primary practice location
118 Gateway Blvd Ste a
Mooresville, NC 28117-6542
Mailing address
118 Gateway Blvd Ste a
Mooresville, NC 28117-6542
Phone (704) 230-1302
Other practice location 1
316 Paseo Reyes Dr
St Augustine, FL 32095-8464
Phone (904) 544-5800
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | baldabagh@pcdermatology.emadirect.md | Direct |
Other providers in Mooresville, NC
- Mahdi Ajjan
- Akashic Connections
- Nadia Akbar
- Paige Marie Akers
- Jennifer Christine Akin
- James Talat Al-Hussaini
- Jessica Jo Albright
- Alchemize Inc
- Alexander Kutuza D.M.D PLLC
- Eileen Frances Alexander LCSW
All providers in Mooresville, NC · MOHS-Micrographic Surgery Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.