Vitaliy Domashevich, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

041756 Issued in CO

Practice address

14100 E Arapahoe Rd
Suite B110
Centennial, CO 80112-4028

Phone

(720) 870-7446

Fax

(720) 870-7460

NPI assigned

Jun 23, 2006

Last updated

May 3, 2024By 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 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO, ME, HI3 enrollments

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 3

Specialty

Anesthesiology

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kauai Medical ClinicGroup PAC ID 5092628479, 147 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wilcox Memorial Hospital Hospital, Lihue, HI, CCN 120014

Merit-based Incentive Payment System (MIPS)

Final score

88.39 of 100Reported as group

Quality

79.9

Promoting interoperability

99

Improvement activities

40

Cost

82.23

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

• Kauai Medical Clinic

  • Multi-Specialty Clinic/Center
  • Lihue, HI
  • NPI 1376596643
  Medicare reassignment Care Compare group NPD
• Advanced Pain and Anesthesia Services, PC

  • Pain Medicine Physician
  • Englewood, CO
  • NPI 1336175546
  Medicare reassignment NPD
• Peak Anesthesia and Pain Management LLC

  • Anesthesiology Physician
  • Centennial, CO
  • NPI 1417063058
  Medicare reassignment NPD
• Kauai Medical Clinic

  • Durable Medical Equipment & Medical Supplies
  • Koloa, HI
  • NPI 1871611558
  NPD
• Metro Denver Anesthesia PC

  • Anesthesiology Physician
  • Denver, CO
  • NPI 1992778724
  NPD (past)
• Kapiolani Medical Center for Women & Children

  dba Kapiolani Medical Center Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Honolulu, HI
  • NPI 1841263720
  NPD (past)

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

• Wilcox Memorial Hospital

  • Rural Acute Care Hospital
  • Lihue, HI
  • NPI 1225113442
  Care Compare affiliation

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1235165440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3405",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801553405",
            "telephone_number": "720-870-7446",
            "fax_number": "720-870-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 E ARAPAHOE RD",
            "address_2": "SUITE B110",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801124028",
            "telephone_number": "720-870-7446",
            "fax_number": "720-870-7460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Bramhall St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041023134",
            "country_code": "US",
            "telephone_number": "207-482-7800",
            "fax_number": "207-482-7898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMASHEVICH",
        "first_name": "VITALIY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ME",
            "license": "MD28222",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "041756",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CO",
            "license": "41756",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235165400",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0971244",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney White Dittmar, MA
• Beatrice Dittmer
• Michelle DO
• Michael Joseph Dobersen, M.D., PH.D.
• Shoshana Dobson
• Allison Dominguez, NONE
• Brittany Dominguez
• Patrick Chace Donathan, ATC, OTC
• Danielle Rae Donlan, PA-C
• Yesim Donmez

• Anesthesiology Physician in Centennial, CO
• Providers in Centennial, CO by specialty
• Anesthesiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; 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.