Individual provider Active NPI

Madison Ayers Domico, DPT

  • Physical Therapist
  • Charlotte, NC
National Provider Identifier
1831818954
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11520 Issued in SC
Practice address
225 Baldwin Ave
Charlotte, NC 28204-3109
Phone
(704) 376-1605
NPI assigned
Aug 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P21483 NC
Physical Therapist 225100000X 11520 SC Primary

Addresses

Primary practice location

225 Baldwin Ave
Charlotte, NC 28204-3109

Mailing address

225 Baldwin Ave
Charlotte, NC 28204-3109
Phone (704) 376-1605

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220915001534 SC Practitioner - Physical Therapist in Private Practice 5294110045 Reassigns benefits to 2 organizations
I20221006002009 NC Practitioner - Physical Therapist in Private Practice 5294110045 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Neurosurgery and Spine Associates PAGroup PAC ID 7214833375, 104 clinicians

Practice addresses (Care Compare)

14135 Ballantyne Corporate PL
Suite 100
Charlotte, NC 28277-3668
Phone (704) 831-4300

550 Mount Holly Medical Pkwy
Belmont, NC 28012-4390
Phone (704) 272-3578

937 Riverwalk Pkwy
Rock Hill, SC 29730-0178
Phone (803) 325-1618

937 Riverwalk Pkwy
Suite 101
Rock Hill, SC 29730-0179
Phone (803) 325-1618

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11520SCMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Atrium Health Specialty Network Inc Physical Therapist CurrentSince Oct 1, 2025 Accepting new patients
Carolina Neurosurgery & Spine Associates PA CurrentSince Aug 22, 2022 Accepting new patients
Carolina Neurosurgery & Spine Associates PA CurrentSince Aug 22, 2022 Accepting new patients
Atrium Health Neurospine Network LLC CurrentSince Oct 1, 2025 Accepting new patients
Atrium Health Neurospine Network LLC CurrentSince Oct 1, 2025 Accepting new patients

Locations

550 Mount Holly Medical Pkwy
Belmont, NC 28012
Phone (704) 272-3578

225 Baldwin Ave
Charlotte, NC 28204
Phone (704) 376-1605

14135 Ballantyne Corporate Pl
Ste 100
Charlotte, NC 28277
Phone (704) 831-4300

9908 Couloak Dr
Ste 100
Charlotte, NC 28216
Phone (704) 801-3065

4525 Cameron Valley Pkwy
Charlotte, NC 28211
Phone (704) 355-5100

110 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 792-2672

937 Riverwalk Pkwy
Ste 101
Rock Hill, SC 29730
Phone (800) 344-6716

937 Riverwalk Pkwy
Rock Hill, SC 29730
Phone (803) 325-1618

Interoperability endpoints

  • FHIR API: https://epicproxy.et0905.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1831818954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMICO",
        "first_name": "MADISON",
        "middle_name": "AYERS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P21483",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "11520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.