Dominique Phua

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3743369 Issued in MI

Practice address

1115 Ball Ave NE
Grand Rapids, MI 49505-5904

Phone

(616) 459-7215

NPI assigned

Nov 7, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Thresholds

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1669488029
  Medicare reassignment NPD
• The Thresholds

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1063068492
  NPD
• The Thresholds

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Westmont, IL
  • NPI 1083590996
  NPD

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

{
    "created_epoch": "1446854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446854400000",
    "number": "1053784413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3249 HUNTINGTON WOODS DR SE",
            "address_2": "APT F",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495128128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 BALL AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055904",
            "telephone_number": "616-459-7215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHUA",
        "first_name": "DOMINIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-07",
        "last_updated": "2015-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "3743369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Stephen Phinney, D.C
• Lamoya Phipps
• Mary Catherine Phipps, RN
• Paige Nicole Phizacklea, RD
• Dessandra Phonxana
• Physical Therapy Services of Grand Rapids, LLC
• Physician'S Home Network, PLLC
• Physicians Dialysis Acquisitions Inc
• Physicians Dialysis Acquisitions Inc
• Physiotherapy Associates Inc

• Addiction (Substance Use Disorder) Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.