NPIMap

Individual provider Active NPI

Domenic A Palagruto, D.O.

  • Family Medicine Physician
  • Southport, NC
National Provider Identifier
1215936356
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
3599 George II Hwy
Southport, NC 28461-7793
Phone
(910) 845-3244
Fax
(910) 845-3276
NPI assigned
Jul 20, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NC Primary

Addresses

Primary practice location

3599 George II Hwy
Southport, NC 28461-7793

Mailing address

3599 George II Hwy
Southport, NC 28461-9766
Phone (910) 845-3244

Other identifiers 2

IdentifierTypeStateIssuer
8913270MedicaidNC
13270OtherNCBC/BS NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040614000540 NC Practitioner - Family Practice 5193709749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boiling Spring Lakes Family Medicine PCGroup PAC ID 6901868587, 3 clinicians

Practice addresses (Care Compare)

3599 George II Hwy
Southport, NC 28461-7793
Phone (910) 845-3244

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions13
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
200100586NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rebecca H. Brown, MD, PA Family Medicine Current Accepting new patients

Locations

3599 George II Hwy
Southport, NC 28461
Phone (910) 845-3244

Interoperability endpoints

  • Direct secure messaging: domenic.palagruto.1@16348.direct.athenahealth.com

Organizations & group practices 2

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

Hospital & facility affiliations 10

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": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215936356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 GEORGE II HWY",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619766",
            "telephone_number": "910-845-3244",
            "fax_number": "910-845-3276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 GEORGE II HWY",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284617793",
            "telephone_number": "910-845-3244",
            "fax_number": "910-845-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALAGRUTO",
        "first_name": "DOMENIC",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8913270",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NUMBER",
            "identifier": "13270",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, NC

Sources for this page

Verify at the official NPI Registry.