Elides Dominguez, CACII
Individual provider Active NPI General Practice Physician · Wesley Chapel, FL
NPI 1124475835 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1124475835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- ACN1111 (FL)
- Practice address
- 2607 Windguard Cir Ste 102
Wesley Chapel, FL 33544-7352 - Phone
- (813) 907-6767
- Fax
- (813) 907-1911
- NPI assigned
- May 23, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PCC Medical Holdings LLC
Practice addresses (Care Compare)
1670 S Congress Ave
PCC of Palm Springs
Palm Springs, FL 33461-2142
Phone (561) 432-4577
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190312002293 | FL | Practitioner - General Practice | 4880934785 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PCC Medical Holdings LLC | Current |
Accepting new patients | |
| Athens Family Medicine LLC | Past | Accepting new patients |
Locations
13377 W Dixie Hwy
Ste 1
North Miami, FL 33161
1140 S Semoran Blvd
Ste E
Orlando, FL 32807
Phone (407) 384-9165
1670 S Congress Ave
Palm Springs, FL 33461
Phone (561) 432-0283
1732 S Congress Ave
Palm Springs, FL 33461
Phone (561) 385-0731
2911 N Military Trl
Ste D
West Palm Beach, FL 33409
Phone (561) 478-8825
6270 Cypress Gardens Blvd
Winter Haven, FL 33884
Phone (863) 318-1111
Interoperability endpoints
- elides.dominguez.1@32578.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | ACN1111 | FL | Yes |
Addresses
Primary practice location
2607 Windguard Cir Ste 102
Wesley Chapel, FL 33544-7352
Mailing address
5626 Curry Ford Rd
Orlando, FL 32822-1424
Phone (407) 985-5677
Other providers in Wesley Chapel, FL
- Doctors Pain Management Group of Wesley Chapel Inc
- Caitlynn Doers
- Dol Doctors LLC
- Magdalena M Dolbrus-Greene
- Jonathan Elgarico Dolutan
- Sameer Dongre
- Double Branch Chiropractic & Rehab
- David Douglas
- Danielle Dowd
- Kyle A Downing
All providers in Wesley Chapel, FL · General Practice Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.