Active NPI
Dominique Caporusso, PA-C
- Medical Physician Assistant
- Erlanger, KY
National Provider Identifier
1225697329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- TC835
- Practice address
- 650 Sprucewood LN
Erlanger, KY 41018-1062 - Phone
- (859) 282-6600
- NPI assigned
- Jun 12, 2019
- Last updated
- Jan 17, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | TC835 | KY | Primary |
Addresses
Primary practice location
650 Sprucewood LN
Erlanger, KY 41018-1062
Mailing address
22 Casagrande St
Fort Thomas, KY 41075-4023
Phone (859) 512-7050
Other names 1
- Dominique Wade
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5414 Hankins Rd
Middletown, OH 45044-9782
Phone (248) 660-1220
7120 Port Sylvania Dr
Toledo, OH 43617-1158
Phone (419) 841-2200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TC835 | KY | MD | Medical Physician Assistant |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1225697329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 CASAGRANDE ST",
"city": "FORT THOMAS",
"state": "KY",
"postal_code": "410754023",
"telephone_number": "859-512-7050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 SPRUCEWOOD LN",
"city": "ERLANGER",
"state": "KY",
"postal_code": "410181062",
"telephone_number": "859-282-6600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAPORUSSO",
"first_name": "DOMINIQUE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-12",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KY",
"license": "TC835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DOMINIQUE",
"last_name": "WADE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Erlanger, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.