Carlo Domingo, AGNP-C
Individual provider Active NPI Gerontology Nurse Practitioner · Hainesville, IL
NPI 1194251272 · NPPES record last updated Oct 11, 2021
Key facts
- NPI
- 1194251272
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 209.019378 (IL)
- Practice address
- 4 N Deer Point Dr
Ste 1002
Hainesville, IL 60030-3814 - Phone
- (847) 946-0198
- NPI assigned
- May 10, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 8
Medicare Care Compare profile
- 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 LLC
Practice addresses (Care Compare)
2405 Big Woods Dr
Batavia, IL 60510-7650
Phone (630) 277-9651
Hospital & facility affiliations
- American Home Care Express Inc
- Meridian Home Health Care Services, Inc
- Reliance Home Health Care, Inc
- All About Healthcare, Inc
- Care Solutions, Inc
- Northwestern Medicine Central Dupage Hospital
- Vista Medical Center East
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200205000961 | IL | Practitioner - Nurse Practitioner | 9537595830 |
Reassigns benefits to 2 organizations Practice locations: Batavia, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.019378 | IL | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Hands Physicians, Inc. | Current |
Accepting new patients | |
| Zeta Visiting Physician LLC | Current |
Accepting new patients |
Locations
4 N Deer Point Rd
Ste 1006
Hainesville, IL 60030
Phone (567) 224-0949
1305 Remington Rd
Ste M
Schaumburg, IL 60173
Phone (224) 938-9264
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 209.019378 | IL | |
| Gerontology Nurse Practitioner | 363LG0600X | 209.019378 | IL | Yes |
Addresses
Primary practice location
4 N Deer Point Dr
Ste 1002
Hainesville, IL 60030-3814
Mailing address
4 N Deer Point Dr.
Ste 1002
Hainesville, IL 60030-3814
Phone (847) 946-0198
Other providers in Hainesville, IL
- Alex Balinao
- David Bronson
- Sara Conner
- Emerson Acupuncture LLC
- Laura Figueroa
- Carol Ann Flatley
- Krystal Fujii
- Hainesville Chirporactic
All providers in Hainesville, IL · Gerontology Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2021. 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.