Carlo Domingo, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209.019378 Issued in IL

Practice address

4 N Deer Point Dr
Ste 1002
Hainesville, IL 60030-3814

Phone

(847) 946-0198

NPI assigned

May 10, 2017

Last updated

Oct 11, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Johns Hopkins University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Zeta Visiting Physician LLCGroup PAC ID 7416489943, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• American Home Care Express Inc Home health agency, Lincolnwood, IL, CCN 147655
• Meridian Home Health Care Services, Inc Home health agency, Libertyville, IL, CCN 148006
• Reliance Home Health Care, Inc Home health agency, Rolling MDWS, IL, CCN 147991
• All About Healthcare, Inc Home health agency, Chicago, IL, CCN 147850
• Care Solutions, Inc Home health agency, Crystal Lake, IL, CCN 147855
• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• Vista Medical Center East Hospital, Waukegan, IL, CCN 140084

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Zeta Visiting Physician LLC

  • General Practice Physician
  • Batavia, IL
  • NPI 1043042484
  Medicare reassignment Care Compare group NPD Authorized official
• Healing Hands Physicians, Inc.

  • Home Health Agency
  • Park Ridge, IL
  • NPI 1275842502
  Medicare reassignment NPD

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

• All About Healthcare, Inc.

  • Home Health Agency
  • Lincolnwood, IL
  • NPI 1568550630
  Care Compare affiliation
• American Home Care Express, Inc.

  • Home Health Agency
  • Lincolnwood, IL
  • NPI 1730186040
  Care Compare affiliation
• Care Solutions, Inc.

  • Home Health Agency
  • Crystal Lake, IL
  • NPI 1285650812
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  dba Northwestern Medicine Central Dupage Hospital

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation
• Meridian Home Health Care Services, Inc.

  • Home Health Agency
  • Libertyville, IL
  • NPI 1073633392
  Care Compare affiliation
• Reliance Home Health Care, Inc.

  • Home Health Agency
  • Rolling Meadows, IL
  • NPI 1588723654
  Care Compare affiliation
• Waukegan Illinois Hospital Company LLC

  dba Vista Medical Center East

  • General Acute Care Hospital
  • Waukegan, IL
  • NPI 1639120694
  Care Compare affiliation

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

{
    "created_epoch": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1194251272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 N DEER POINT DR.",
            "address_2": "STE 1002",
            "city": "HAINESVILLE",
            "state": "IL",
            "postal_code": "600303814",
            "telephone_number": "847-946-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 N DEER POINT DR",
            "address_2": "STE 1002",
            "city": "HAINESVILLE",
            "state": "IL",
            "postal_code": "600303814",
            "telephone_number": "847-946-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "CARLO",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-10",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.019378",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.019378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Hainesville, IL
• Providers in Hainesville, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.