Ivan Dominguez, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

021391 Issued in PR

Practice address

1462 Calle Prof Augusto Rodriguez
San Juan, PR 00909-2199

Phone

(787) 727-6060

NPI assigned

Nov 10, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Vascular Surgery

Education

Ponce School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Metro Santurce IncGroup PAC ID 7618973124, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospital Pavia Santurce Hospital, San Juan, PR, CCN 400019

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Metro Santurce, Inc.

  • General Acute Care Hospital
  • San Juan, PR
  • NPI 1467417865

  PR

  Medicare reassignment Care Compare group NPD

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

• Metro Santurce, Inc.

  • General Acute Care Hospital
  • San Juan, PR
  • NPI 1467417865

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1104070705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11137",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009102237",
            "telephone_number": "787-641-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 CALLE PROF AUGUSTO RODRIGUEZ",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009092199",
            "telephone_number": "787-727-6060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 High St",
            "address_2": "Ste A2",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031126",
            "country_code": "US",
            "telephone_number": "716-859-3301",
            "fax_number": "716-859-3398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-10",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "265300",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PR",
            "license": "021391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "none",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "none",
            "address_1": "1462 Calle Prof Augusto Rodriguez",
            "city": "San Juan",
            "state": "PR",
            "country_code": "US",
            "postal_code": "009092199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lissette Marie Dominguez Bruno
• Fabian A. Dominguez Carde
• Antonio Dominguez Romero, MD
• Dimaris Dominguez-Ayala, M.D.
• Esmeralda Dominguez
• Jorge Dominguez, MD
• Metsiel J Donate, PHARM DC
• Zahidee Liz Donato-Ruiz
• Luisa Done
• Vivianette Dones Birriel, MSW

• All providers in San Juan, PR
• Vascular Surgery Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.