Individual provider Active NPI

July Romely Damour, PA-C

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1851470215
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2081 Issued in SC
Practice address
3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone
(910) 742-9243
Fax
(888) 746-1787
NPI assigned
Nov 4, 2006
Last updated
Apr 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2081 SC Primary
Physician Assistant 363A00000X 010521 NY
Medical Physician Assistant 363AM0700X 2081 SC
Medical Physician Assistant 363AM0700X 9105236 FL

Addresses

Primary practice location

3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565

Mailing address

PO Box 538622
Atlanta, GA 30353-8622
Phone (910) 742-9243

Other identifiers 2

IdentifierTypeStateIssuer
00246075MedicaidNY
002165400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, 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
I20140703002176 SC Practitioner - Physician Assistant 2567656457 Reassigns benefits to 2 organizations
I20170626000484 NC Practitioner - Physician Assistant 2567656457 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, shared by 9 NPIs, 172 clinicians
Lifesource Prime IncGroup PAC ID 7810336385, shared by 3 NPIs, 52 clinicians

Practice addresses (Care Compare)

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

939 Springdale Dr
Clinton, SC 29325-7266
Phone (910) 742-9243

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
010521NYMDPhysical Therapy Assistant
9105236FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource Prime Inc CurrentSince Nov 15, 2025 Accepting new patients
Lifesource Prime Inc CurrentSince Dec 1, 2025 Accepting new patients
Lifesource of North Carolina Physician Assistant CurrentSince Apr 15, 2014 Accepting new patients
Lifesource of North Carolina Physician Assistant CurrentSince Feb 1, 2022 Accepting new patients
Lifesource Prime Inc Physician Assistant CurrentSince Nov 15, 2025 Accepting new patients
Lifesource of North Carolina Physician Assistant CurrentSince Apr 15, 2014 Accepting new patients

Locations

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

1915 Ebenezer Rd
Rock Hill, SC 29732
Phone (305) 866-9951

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1162598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1851470215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538622",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303538622",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 RANDALL PKWY STE 105",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032565",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMOUR",
        "first_name": "JULY",
        "middle_name": "ROMELY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-04",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2081",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010521",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "2081",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9105236",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002165400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.