Timothy L. Dagenhart, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38036 Issued in NC

Practice address

1904 Jake Alexander Blvd W
Ste 301
Salisbury, NC 28147-1178

Phone

(704) 638-1551

Fax

(704) 638-1553

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Main Street Family Practice of China Grove PC

  • Family Medicine Physician
  • China Grove, NC
  • NPI 1619279247
  Medicare reassignment NPD
• Main Street Family Practice PC

  • Family Medicine Physician
  • China Grove, NC
  • NPI 1760489629
  NPD

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1376597823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "704-638-1551",
            "fax_number": "704-638-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 JAKE ALEXANDER BLVD W",
            "address_2": "STE 301",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471178",
            "telephone_number": "704-638-1551",
            "fax_number": "704-638-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGENHART",
        "first_name": "TIMOTHY",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "38036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8926738",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Dennis Cusack, DPM
• Melissa Custis, PMHNP
• CVS Health
• Justino Christopher D'Mello, M.D.
• Edmund D D'Orazio, M. D.
• Cindy Walker Dail
• Daniel Max & Marc Andrea LLC
• Jalaja R Dasari, M.D
• David E Thome DDS PA I
• David E Thome DDS PLLC I

• Family Medicine Physician in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.