Active NPI
Bessie Smithers Dominguez, M.D.
- General Practice Physician
- Chicago, IL
National Provider Identifier
1073627634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 036-058438
- Practice address
- 5159 W Fullerton Ave
Chicago, IL 60639-2403 - Phone
- (773) 637-6623
- Fax
- (773) 637-6622
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036058438 | IL | |
| General Practice Physician | 208D00000X | 036-058438 | IL | Primary |
Addresses
Primary practice location
5159 W Fullerton Ave
Chicago, IL 60639-2403
Mailing address
5159 W. Fullerton Avenue
Chicago, IL 60639-2408
Phone (773) 637-6622
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 316-01173 | Other | IL | BC/BC PN |
| 156321253824 | Other | IL | HUMANA PN |
| 036058438 | Medicaid | IL | |
| 0000516 | Other | IL | UNICARE PN |
| 0100289 | Other | IL | UHC PN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036058438 | IL | MD | Family Medicine Physician |
| 036-058438 | IL | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232409600000",
"number": "1073627634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5159 W. FULLERTON AVENUE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606392408",
"telephone_number": "773-637-6622",
"fax_number": "773-637-6622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5159 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606392403",
"telephone_number": "773-637-6623",
"fax_number": "773-637-6622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "BESSIE",
"middle_name": "SMITHERS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2009-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036058438",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "036-058438",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BC PN",
"identifier": "316-01173",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA PN",
"identifier": "156321253824",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036058438",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNICARE PN",
"identifier": "0000516",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC PN",
"identifier": "0100289",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.