Individual provider Active NPI

Dominique Ann Lawrence, P.A.-C

  • Medical Physician Assistant
  • Austin, TX
National Provider Identifier
1023360237
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10222 Issued in TX
Practice address
2901 Montopolis Dr
Austin, TX 78741-6411
Phone
(512) 978-9901
Fax
(512) 901-9765
NPI assigned
Oct 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA10222 TX Primary
Physician Assistant 363A00000X 1085 AK

Addresses

Primary practice location

2901 Montopolis Dr
Austin, TX 78741-6411

Mailing address

2901 Montopolis Dr
Austin, TX 78741-6411
Phone (512) 978-9901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20121126000170 TX Practitioner - Physician Assistant 9739330713 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tanana Chiefs ConferenceGroup PAC ID 9537050109, 148 clinicians

Practice addresses (Care Compare)

1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682

Hospital & facility affiliations

  • Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2229AKMDPharmacist
PA10222TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Chiefs Conference CurrentSince Jun 22, 2020 Accepting new patients
Ascension Seton CurrentSince Feb 14, 2017 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Jun 15, 2021 Accepting new patients
Ascension Seton CurrentSince Feb 14, 2017 Accepting new patients

Locations

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

1400 N Interstate 35
Ste 300
Austin, TX 78701
Phone (512) 324-8300

6001 Kyle Pkwy
Kyle, TX 78640
Phone (512) 504-5000

130 Hays St
Ste Bd
Luling, TX 78648
Phone (830) 875-7000

Interoperability endpoints

  • Direct secure messaging: dominique.lawrence.2@15989.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1349913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1023360237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 MONTOPOLIS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787416411",
            "telephone_number": "512-978-9901",
            "fax_number": "512-901-9765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 MONTOPOLIS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787416411",
            "telephone_number": "512-978-9901",
            "fax_number": "512-901-9765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "DOMINIQUE",
        "middle_name": "ANN",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-11",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA10222",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "1085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.