Theresa M Domagola, ACNP-BC, PMHNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

11002747 Issued in FL

Practice address

15255 Max Leggett Pkwy Ste 3600
Jacksonville, FL 32218-7279

Phone

(904) 427-6895

NPI assigned

May 16, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY, FL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

University of Rochester School of Medicine and Dentistry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, 908 clinicians

Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score

59.59 of 100Reported as apm

Quality

59.93

Promoting interoperability

0

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  Medicare reassignment Care Compare group NPD
• University of Florida Jacksonville Physicians, Inc.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1144276452
  Medicare reassignment Care Compare group NPD
• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712
  Medicare reassignment NPD
• Western New York Medical Practice P.C.

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1063790608
  Medicare reassignment NPD
• Peace of Mind Amelia, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fernandina Beach, FL
  • NPI 1275346553
  NPD Authorized official
• University of Florida Jacksonville Physicians Inc

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1851551121
  NPD
• University of Florida Jacksonville Physicians, Inc.

  • Physiological Laboratory
  • Jacksonville, FL
  • NPI 1831800952
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD

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

• Shands Jacksonville Medical Center Inc

  • Urgent Care Clinic/Center
  • Jacksonville, FL
  • NPI 1144962408

  Hospital

  Care Compare affiliation
• Shands Jacksonville Medical Center Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1821186313
  Care Compare affiliation

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1184676322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15255 MAX LEGGETT PKWY STE 3600",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187279",
            "telephone_number": "904-427-6895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15255 MAX LEGGETT PKWY STE 3600",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187279",
            "telephone_number": "904-427-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMAGOLA",
        "first_name": "THERESA",
        "middle_name": "M",
        "credential": "ACNP-BC, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "430210",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11002747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR",
            "identifier": "70008ARA6884",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02601196",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Dollick
• Dolores a. Loveless MD, PA
• Angelica U Doloroso, APRN
• Dolphin Pointe Health Care, LLC
• Sona Dolsenhe, ARNP
• Eric Dombroski, D.O
• Keisey Kathleen Dombrowski, AA
• Deborah Kay Domen, R.D.H.
• Michael E. Domery, PSY.D.
• Harrison Domeshek

• Acute Care Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Acute Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.