NPIMap

Individual provider Active NPI

Dominic James Chiappetta, RPA-C

  • Surgical Physician Assistant
  • Daytona Beach, FL
National Provider Identifier
1699024877
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA 9108080 Issued in FL
Practice address
305 Memorial Medical Pkwy Ste 505
Daytona Beach, FL 32117-5170
Phone
(386) 231-3540
Fax
(386) 231-3544
NPI assigned
Sep 5, 2012
Last updated
Jan 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 005811 NY
Surgical Physician Assistant 363AS0400X PA 9108080 FL Primary
Acupuncturist 171100000X 001645-1 NY

Addresses

Primary practice location

305 Memorial Medical Pkwy Ste 505
Daytona Beach, FL 32117-5170

Mailing address

PO Box 947381
Atlanta, GA 30394-7381
Phone (386) 231-3540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20150609000199 FL Practitioner - Physician Assistant 0941432389 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1 Adventhealth Way
Palm Coast, FL 32137-4702
Phone (386) 302-1800

1055 Saxon Blvd
Orange City, FL 32763-8468
Phone (386) 917-5000

1200 Lexington Green LN
Sanford, FL 32771-1013

3 Adventhealth Way
Palm Coast, FL 32137-4702

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001645-1NYMDOccupational Therapist
PA 9108080FLMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Holy Cross Hospital, Inc CurrentSince Feb 23, 2015 Accepting new patients
Holy Cross Hospital Inc CurrentSince Feb 23, 2015 Accepting new patients

Locations

1309 S Federal Hwy
#G
Ft Lauderdale, FL 33316
Phone (954) 463-4383

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: dchiappetta967569@adventhealth.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1699024877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947381",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947381",
            "telephone_number": "386-231-3540",
            "fax_number": "386-231-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MEMORIAL MEDICAL PKWY STE 505",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175170",
            "telephone_number": "386-231-3540",
            "fax_number": "386-231-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIAPPETTA",
        "first_name": "DOMINIC",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-05",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "005811",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA 9108080",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "001645-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.