Dallas Lee Domangue, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

T-4248 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 984-1000

NPI assigned

Mar 26, 2021

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 LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Louisiana State University School of Medicine in New Orleans, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thibodaux Regional Network Development CorporationGroup PAC ID 8224011754, 138 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Thibodaux Regional Medical Center Hospital, Thibodaux, LA, CCN 190004

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Thibodaux Regional Network Development Corporation

  • Anesthesiology Physician
  • Thibodaux, LA
  • NPI 1285658310
  Medicare reassignment Care Compare group NPD
• Zephyr Anesthesia, LLC

  • Anesthesiology Physician
  • La Place, LA
  • NPI 1891087458
  Medicare reassignment
• Thibodaux Regional Network Development Corporation

  • Foot & Ankle Surgery Podiatrist
  • Thibodaux, LA
  • NPI 1043836166
  NPD
• Thibodaux Regional Network Development Corporation

  • Clinical Cardiac Electrophysiology Physician
  • Thibodaux, LA
  • NPI 1770435851
  NPD
• Thibodaux Regional Network Development Corporation

  • Diagnostic Radiology Physician
  • Thibodaux, LA
  • NPI 1467427336
  NPD (past)

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

• Thibodaux Regional Health System Inc

  • General Acute Care Hospital
  • Thibodaux, LA
  • NPI 1902465065
  Care Compare affiliation

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625270400000",
    "number": "1205413010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PARKWAY DR APT 1103",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114212",
            "telephone_number": "985-860-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMANGUE",
        "first_name": "DALLAS",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2021-07-03",
        "certification_date": "2021-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "T-4248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Doddato, RN, PH.D
• Ali Dodge-Khatami, MD
• Shireen Dogar, MD
• Joseph Edward Doherty, MD
• Michael Doherty, MD
• Marlee Hope Domangue
• Maria Paula Domino, M.D.
• Abby Donaho, INTERN
• Nakeisha Donald
• Donald'S Home

• Anesthesiology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Anesthesiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.