NPIMap

Individual provider Active NPI

Crispin Rabara Domingo Jr., M.D.

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1043354376
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49398 Issued in MN
Practice address
4801 Veterans Dr
Saint Cloud, MN 56303-2015
Phone
(320) 252-1670
Fax
(320) 355-6359
NPI assigned
Feb 19, 2007
Last updated
Jan 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 49398 MN Primary

Addresses

Primary practice location

4801 Veterans Dr
Saint Cloud, MN 56303-2015

Mailing address

4801 Veterans Dr
Saint Cloud, MN 56303-2015
Phone (320) 252-1670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20080121000325 MN Practitioner - Family Practice 7315028958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630

9855 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 581-2273

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49398MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Jan 1, 2022 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Jan 1, 2022 Accepting new patients
North Memorial Health Care CurrentSince Jan 19, 2019 Accepting new patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince Jan 19, 2019 Accepting new patients
Now Medical, Inc Past Accepting new patients
PHS Indian Hospital Past Accepting new patients

Locations

5615 Xerxes Ave N
Brooklyn Center, MN 55430
Phone (763) 581-5630

800 Freeport Ave NW
Ste 100
Elk River, MN 55330
Phone (763) 581-5200

12000 Elm Creek Blvd N
Ste 140
Maple Grove, MN 55369
Phone (763) 420-5279

9855 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-5140

9855 Hospital Dr
Ste 102A
Maple Grove, MN 55369
Phone (763) 581-9220

9855 Hospital Dr
Ste 104
Maple Grove, MN 55369
Phone (763) 581-5900

327 Central Ave SE
Minneapolis, MN 55414
Phone (612) 379-1119

8301 Golden Valley Rd
Ste 300
Minneapolis, MN 55427
Phone (224) 306-1879

2000 Plymouth Rd
Ste 100
Minnetonka, MN 55305
Phone (763) 581-5250

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

2600 39th Ave NE
Saint Anthony, MN 55421
Phone (612) 706-2690

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: cdomingo613350@direct.centracare.com

Organizations & group practices 8

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": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1043354376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 VETERANS DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032015",
            "telephone_number": "320-252-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 VETERANS DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032015",
            "telephone_number": "320-252-1670",
            "fax_number": "320-355-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "CRISPIN",
        "middle_name": "RABARA",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "49398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.