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DR. DAGIM DESTA MD
NPI 1366024978
Internal Medicine in Staten Island, NY

Active since April 22, 2021PECOS Enrolled
355 BARD AVENUE DEPT. OF MEDICINE VILLA BLDG 1ST FLOOR, STATEN ISLAND, NY 10310(718) 818-2419 Get Directions Write a Review

NPPES record last updated: December 24, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 24, 2024, Apr 22, 2021 (2 updates tracked since 2021).

About Dr. Dagim Desta Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DAGIM DESTA MD (NPI 1366024978) is an individual internal medicine provider in Staten Island, New York, licensed in Georgia (102742) and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS, is affiliated with Tanner Medical Center - Carrollton, and is a graduate of Other (2003).

NPPES Registry Identity

NPI1366024978
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. DAGIM DESTACredential: MD
Location Address355 BARD AVENUE DEPT. OF MEDICINE VILLA BLDG 1ST FLOORStaten Island, NY 10310
Mailing Address355 Bard Avenue Dept. Of Medicine Villa Bldg 1st FStaten Island, NY 10310 · (718) 818-2419
Phone(718) 818-2419
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateApril 22, 2021
Last NPPES UpdateDecember 24, 20242 updates tracked since enumeration
NPPES CertifiedDecember 24, 2024
✔ NPI 1366024978 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in GA · 102742
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
355 BARD AVENUE DEPT. OF MEDICINE VILLA BLDG 1ST FLOOR, Staten Island, NY 10310
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Dagim Desta Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9830628445
PECOS Enrollment IDI20250128002097
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Dagim Desta reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Wellstar Medical Group, LLC
721 mi
Family Medicine
11685 ALPHARETTA HWY, SUITE 300
Roswell, GA 30076
  • Reassigned Medicare billing, Georgia enrollment
  • 3,885 clinicians in this Medicare group
NPI 1922405729 (678) 325-6611
Apogee Medical Group Georgia Inc
776 mi
Internal Medicine
705 DIXIE ST
Carrollton, GA 30117
  • Reassigned Medicare billing, Georgia enrollment
  • 335 clinicians in this Medicare group
NPI 1629025143 (770) 836-9667

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Tanner Medical Center - Carrollton

Acute Care Hospitals · Carrollton, GA
3/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110011
Location705 Dixie StreetCarrollton, GA 30117 · Carroll County
Birthing friendly

Tanner Medical Center Villa Rica

Acute Care Hospitals · Villa Rica, GA
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110015
Location601 Dallas HighwayVilla Rica, GA 30180 · Carroll County
Emergency services Birthing friendly

Wellstar Paulding Medical Center

Acute Care Hospitals · Hiram, GA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number110042
Location2518 Jimmy Lee Smith ParkwayHiram, GA 30141 · Paulding County

Wellstar Cobb Medical Center

Acute Care Hospitals · Austell, GA
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number110143
Location3950 Austell RdAustell, GA 30106 · Cobb County
Birthing friendly

Higgins General Hospital

Critical Access Hospitals · Bremen, GA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number111320
Location200 Allen Memorial DriveBremen, GA 30110 · Haralson County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10310 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$154.28 typical visit price
range $67.40 – $203.53
Typical copayment $38.57 (range $16.85 – $50.88)
Most-billed visit code 99204
Established Patient
$117.62 typical visit price
range $21.66 – $164.45
Typical copayment $29.40 (range $5.41 – $41.11)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dagim Desta's NPI number?

The NPI number for Dagim Desta is 1366024978. It was assigned to this individual provider in the NPPES registry on April 22, 2021.

Where is Dagim Desta located?

Dagim Desta practices at 355 Bard Avenue Dept. Of Medicine Villa Bldg 1st Floor, Staten Island, NY 10310. The listed phone number is (718) 818-2419.

What is Dagim Desta's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Dagim Desta enrolled in Medicare?

Yes. Dagim Desta is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Dagim Desta's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dagim Desta reassigns Medicare benefits to 2 organizations: Wellstar Medical Group, LLC (Roswell, GA) and Apogee Medical Group Georgia Inc (Carrollton, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dagim Desta's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Dagim Desta accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 1 other insurer list Dagim Desta as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Dagim Desta affiliated with any hospitals?

According to CMS data, Dagim Desta is affiliated with Tanner Medical Center - Carrollton, Tanner Medical Center Villa Rica, Wellstar Paulding Medical Center, Wellstar Cobb Medical Center and Higgins General Hospital.

When was this NPI record last updated?

The NPPES record for Dagim Desta was last updated on December 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.