NPIMap

Individual provider Active NPI

Domenic Marini, M.D.

  • Interventional Cardiology Physician
  • Palm Coast, FL
National Provider Identifier
1184688251
Registry record updated Dec 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
ME80454 Issued in FL
Practice address
19 Old Kings Rd N
Suite C-106
Palm Coast, FL 32137-8260
Phone
(386) 446-6540
Fax
(386) 447-7732
NPI assigned
Apr 14, 2006
Last updated
Dec 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME80454 FL
Interventional Cardiology Physician 207RI0011X ME80454 FL Primary

Addresses

Primary practice location

19 Old Kings Rd N
Suite C-106
Palm Coast, FL 32137-8260

Mailing address

19 Old Kings Rd N
Suite C-106
Palm Coast, FL 32137-8260
Phone (386) 446-6540

Other identifiers 2

IdentifierTypeStateIssuer
AX630OtherFLMEDICARE GROUP NUMBER
17609OtherFLBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051229000409 FL Practitioner - Cardiovascular Disease (Cardiology) 2668494980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Georgetown University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19 Old Kings Rd N
Suite C101
Palm Coast, FL 32137-8261
Phone (386) 446-6540

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME80454FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Coast Cardiovascular Institute PL Specialist CurrentSince Sep 22, 2008 Accepting new patients
Memorial Health Systems Inc Past Accepting new patients
Memorial Hospital Flagler Inc Past Accepting new patients

Locations

19 Old Kings Rd N
Ste C101
Palm Coast, FL 32137
Phone (386) 445-8546

19 Old Kings Rd N
Ste C106
Palm Coast, FL 32137
Phone (386) 446-4540

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BHCJAA
  • FHIR API: https://fhir4.healow.com/fhir/r4/BHCJAA/Endpoint/BHCJAA

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229558400000",
    "number": "1184688251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 OLD KINGS RD N",
            "address_2": "SUITE C-106",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378260",
            "telephone_number": "386-446-6540",
            "fax_number": "386-447-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OLD KINGS RD N",
            "address_2": "SUITE C-106",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378260",
            "telephone_number": "386-446-6540",
            "fax_number": "386-447-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINI",
        "first_name": "DOMENIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2008-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME80454",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME80454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "AX630",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "17609",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.