Dagim Desta, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

102742 Issued in GA

Practice address

355 Bard Avenue Dept. of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310

Phone

(718) 818-2419

NPI assigned

Apr 22, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hospitalist

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Apogee Medical Group GeorgiaGroup PAC ID 4587676945, 122 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011
• Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
• Higgins General Hospital Hospital, Bremen, GA, CCN 111320
• Tanner Medical Center-East Alabama Hospital, Wedowee, AL, CCN 011306

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Apogee Medical Group Georgia

  • Internal Medicine Physician
  • Carrollton, GA
  • NPI 1629025143
  Medicare reassignment Care Compare group NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group

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

• Paulding Medical Center, Inc.

  • General Acute Care Hospital
  • Hiram, GA
  • NPI 1457329435
  Care Compare affiliation
• Tanner Medical Center Alabama Inc

  • Critical Access Hospital
  • Wedowee, AL
  • NPI 1912428301
  Care Compare affiliation
• Tanner Medical Center, Inc

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Higgins General Hospital

  • Critical Access Hospital
  • Bremen, GA
  • NPI 1194712083
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734998400000",
    "number": "1366024978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVENUE DEPT. OF MEDICINE VILLA BLDG 1ST F",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10310",
            "telephone_number": "718-818-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVENUE DEPT. OF MEDICINE VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10310",
            "telephone_number": "718-818-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTA",
        "first_name": "DAGIM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "102742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Desimone, M.A., CCC-SLP
• Benjamin Desir
• Maykel Desir
• Antonio G Desposito, DC
• Hilde Emmaline Dessalines
• Carmine Salvatore Destefano, LMSW
• Charles Destefano, PH.D.
• Janey Detommaso, OTR
• Caroline Bernadette Detota, RN
• Detox

• Internal Medicine Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.