Justin Domenico

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

100 E Lancaster Ave
Wynnewood, PA 19096-3450

Phone

(484) 476-2000

NPI assigned

Sep 6, 2019

Sex

Male

Sole proprietor

No

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 PA

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• University of Penn-Medical Group

  • Hematology & Oncology Physician
  • Philadelphia, PA
  • NPI 1679677975
  Medicare reassignment Care Compare group NPD
• Main Line Emergency Med Associates LLC

  • Emergency Medicine Physician
  • Paoli, PA
  • NPI 1316919368
  Medicare reassignment
• Tower Health Urgent Care, LLC

  • Emergency Medicine Physician
  • Douglassville, PA
  • NPI 1194293647
  Medicare reassignment
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567728000000",
    "number": "1053960690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 VILLA RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190261435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963450",
            "telephone_number": "484-476-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMENICO",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-06",
        "last_updated": "2019-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Direct Draws Corporation
• Nikki Anna Doerr
• James Doherty, MD
• Bevin Lashley Dolan, MD
• Domenic Baglivo Jr D.M.D., P.C
• Justin Domingo, MD
• Steven Domsky, MD
• Ashley Domzalski, MSPAS
• Charles Donahue, MSA
• Donald J Corey

• Physician Assistant in Wynnewood, PA
• Providers in Wynnewood, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; 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.