Kimberly Marie Domalewicz, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

341343 Issued in NY

Practice address

2231 Burdett Ave Ste 110
Troy, NY 12180-2447

Phone

(518) 271-3900

Fax

(518) 271-3914

NPI assigned

Jul 12, 2017

Last updated

Jun 29, 2022By the provider in NPPES

Sex

Female

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 NY

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

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Hospital of Troy, New YorkGroup PAC ID 6507770070, 258 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdomalewicz1854224@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727
  Medicare reassignment Care Compare group NPD
• St. Peter's Health Partners Medical Associates, P.C.

  • Multi-Specialty Clinic/Center
  • Albany, NY
  • NPI 1750626834
  Medicare reassignment NPD
• W Bruce Clark MD PC

  • Obstetrics & Gynecology Physician
  • Latham, NY
  • NPI 1396959110
  Medicare reassignment NPD
• Lee and Burack OB/GYN, P.C.

  • Obstetrics & Gynecology Physician
  • Albany, NY
  • NPI 1801983788
  NPD (past)

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

• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727
  Care Compare affiliation

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1114449030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 BURDETT AVE STE 110",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802447",
            "telephone_number": "518-271-3900",
            "fax_number": "518-271-3914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "855 Route 146",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120653885",
            "country_code": "US",
            "telephone_number": "518-373-4555",
            "fax_number": "518-371-3839",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "713 Troy Schenectady Rd Ste 304",
            "address_purpose": "LOCATION",
            "city": "Latham",
            "state": "NY",
            "postal_code": "121102490",
            "country_code": "US",
            "telephone_number": "518-786-6270",
            "fax_number": "518-786-6276",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Empire Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "NY",
            "postal_code": "121445730",
            "country_code": "US",
            "telephone_number": "518-373-4555",
            "fax_number": "518-286-4974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2231 Burdett Ave Ste 160",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802453",
            "country_code": "US",
            "telephone_number": "518-326-1620",
            "fax_number": "518-326-1622",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-271-3900",
            "fax_number": "518-271-3914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMALEWICZ",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341343",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "341343",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP - Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2231 Burdett Ave Ste 110",
            "city": "Troy",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121802447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amberrose Eileen Dische, SLP
• Cynthia Jean Disorbo, RN
• Marius Killian Nikolas Ditursi, M.D., PH.D.
• Divya Divakaran, MS-CF
• Amelia M Dodge, LCSW
• Megan Donahue
• Donna Heffernan MD PLLC
• Carolyn Donovan
• Jacqueline M Dorn, LCSW
• Janice Dort

• Family Nurse Practitioner in Troy, NY
• Providers in Troy, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.