Bishr Al Dabagh, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

2019-01570 Issued in NC

Practice address

118 Gateway Blvd Ste a
Mooresville, NC 28117-6542

Phone

(704) 230-1302

NPI assigned

Apr 28, 2009

Last updated

Jan 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 8

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

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 PLLCGroup PAC ID 6305272543, 6 clinicians

Bold City Dermatology LLCGroup PAC ID 2769897974, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: baldabagh@boldcityderm.emadirect.md
• Direct secure messaging: baldabagh@foradermatology.emadirect.md
• Direct secure messaging: baldabagh@pcdermatology.emadirect.md
• Direct secure messaging: baldabagh744299@direct.shands.ufl.edu
• FHIR API: https://fhir4.healow.com/fhir/r4/CJECBA

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.

• Fora Dermatology PLLC

  • MOHS-Micrographic Surgery Physician
  • Mooresville, NC
  • NPI 1366086597

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Bold City Dermatology LLC

  • MOHS-Micrographic Surgery Physician
  • St Augustine, FL
  • NPI 1538761655

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Darst Dermatology, PC

  • Dermatology Physician
  • Charlotte, NC
  • NPI 1740434158
  Medicare reassignment NPD
• Dermatology Center of Shelby PA

  dba Joseph J Urash

  • Dermatology Physician
  • Shelby, NC
  • NPI 1710940887
  Medicare reassignment NPD
• Brent M Boyce MD PC

  dba Saginaw Bay Dermatology

  • Medical Physician Assistant
  • Sebewaing, MI
  • NPI 1982736054
  NPD
• Charlotte Dermatopathology, Inc

  • Clinical Medical Laboratory
  • Charlotte, NC
  • NPI 1558515965
  NPD (past)
• Hawaiian Islands Dermatology, LLC

  • Dermatology Physician
  • Kailua, HI
  • NPI 1891310355
  NPD (past)

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1154565661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 GATEWAY BLVD STE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176542",
            "telephone_number": "704-230-1302",
            "fax_number": "704-230-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 GATEWAY BLVD STE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176542",
            "telephone_number": "704-230-1302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "316 Paseo Reyes Dr",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320958464",
            "country_code": "US",
            "telephone_number": "904-544-5800",
            "fax_number": "904-544-5800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL DABAGH",
        "first_name": "BISHR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-28",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301106561",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "HI",
            "license": "MD17679",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "HI",
            "license": "MD17679",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME142263",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MI",
            "license": "4301106561",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "49483",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A125540",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "2019-01570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "baldabagh@pcdermatology.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Direct Mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "118 Gateway Blvd Ste A",
            "city": "Mooresville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281176542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mahdi Ajjan, M.D.
• Akashic Connections
• Nadia Akbar, MD
• Paige Marie Akers, FNP
• Jennifer Christine Akin, OTR L
• James Talat Al-Hussaini, MD
• Jessica Jo Albright, OTR/L
• Alchemize Inc
• Alexander Kutuza D.M.D PLLC (Kutuza Endodontics LLC)
• Eileen Frances Alexander LCSW, MSW

• MOHS-Micrographic Surgery Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• MOHS-Micrographic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.