Individual provider Active NPI

Roberto A Marsico Jr., PA-C

  • Physician Assistant
  • Concord, NC
National Provider Identifier
1225404635
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001010564 Issued in NC
Practice address
391 George W Liles Pkwy NW
Concord, NC 28027-8218
Phone
(713) 993-7344
NPI assigned
Aug 19, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085005562 IL
Physician Assistant 363A00000X 001010564 NC Primary

Addresses

Primary practice location

391 George W Liles Pkwy NW
Concord, NC 28027-8218

Mailing address

9929 Elsenham LN
Charlotte, NC 28269-8339
Phone (630) 777-8388

Other practice location 1

1501 S California Ave
Chicago, IL 60608-1732
Phone (630) 777-8388

Other practice location 2

3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190314001968 PA Practitioner - Physician Assistant 7012282395 Reassigns benefits to 1 organization
I20201118002154 NC Practitioner - Physician Assistant 7012282395 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians
Lifesource Prime IncGroup PAC ID 7810336385, 52 clinicians

Practice addresses (Care Compare)

3205 Randall Pkwy
Suite 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Shelby, NC, CCN 347317
  • Bayada Home Health Care, Inc Home health agency, Salisbury, NC, CCN 347325
  • Hospice of Davidson County/ Hinkle Hospice House Hospice, Lexington, NC, CCN 341553

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001010564NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pai Participant 29, P.C. CurrentSince Aug 10, 2025 Accepting new patients

Locations

211 Milton Brown Heirs Rd
Boone, NC 28607
Phone (828) 264-6720

279 Brian Center Dr
Lexington, NC 27292
Phone (336) 236-8114

1287 Newsome St
Mount Airy, NC 27030
Phone (336) 786-2133

1028 Blair St
#540N
Thomasville, NC 27360
Phone (336) 472-7771

Interoperability endpoints

  • Direct secure messaging: rmarsico664304@direct.medicine.duke.edu
  • Direct secure messaging: rmarsico500479@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 10

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 3

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": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1225404635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9929 ELSENHAM LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282698339",
            "telephone_number": "630-777-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 GEORGE W LILES PKWY NW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280278218",
            "telephone_number": "713-993-7344"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 S California Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606081732",
            "country_code": "US",
            "telephone_number": "630-777-8388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3205 Randall Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032565",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSICO",
        "first_name": "ROBERTO",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-19",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085005562",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001010564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.