Individual provider Active NPI

Dominique Hunt, PA

  • Physician Assistant
  • Dayton, OH
National Provider Identifier
1104201730
Registry record updated Oct 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004200 Issued in OH
Practice address
5300 Far Hills Ave Ste 300
Dayton, OH 45429-2381
Phone
(937) 433-7536
Fax
(937) 433-9612
NPI assigned
Jul 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.004200 OH Primary

Addresses

Primary practice location

5300 Far Hills Ave Ste 300
Dayton, OH 45429-2381

Mailing address

Attn: Nicole Kyne
7835 Paragon Rd.
Dayton, OH 45459-4021
Phone (937) 436-4148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20160328001353 OH Practitioner - Physician Assistant 5799082236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatologists of Southwestern Ohio, LLCGroup PAC ID 7113973041, 116 clinicians

Practice addresses (Care Compare)

45 S Stanfield Rd
Troy, OH 45373-2366
Phone (937) 339-8380

5300 Far Hills Ave
Dayton, OH 45429-2381
Phone (937) 433-7536

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.004200OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1104201730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ATTN: NICOLE KYNE",
            "address_2": "7835 PARAGON RD.",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454594021",
            "telephone_number": "937-436-4148",
            "fax_number": "937-434-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 FAR HILLS AVE STE 300",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292381",
            "telephone_number": "937-433-7536",
            "fax_number": "937-433-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUNT",
        "first_name": "DOMINIQUE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-24",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.