Maxfelonilo A Domingo, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

ME0043605 Issued in FL

Practice address

760 SE 5TH Terrace
Crystal River, FL 34429-4852

Phone

(352) 795-4165

Fax

(352) 795-3659

NPI assigned

Sep 26, 2007

Last updated

Oct 8, 2009By 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 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Maxfelonilo a Domingo MD PA

  • Cardiovascular Disease Physician
  • Crystal River, FL
  • NPI 1871528489
  Authorized official Same address or phone
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254960000000",
    "number": "1235326984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 W HIGHLAND BLVD",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524716",
            "telephone_number": "352-726-8353",
            "fax_number": "352-726-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 SE 5TH TERRACE",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344294852",
            "telephone_number": "352-795-4165",
            "fax_number": "352-795-3659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "MAXFELONILO",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-26",
        "last_updated": "2009-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME0043605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "77940",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000755600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11379665",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF FL",
            "identifier": "79947",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP",
            "identifier": "CF1416",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "ME43605",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "06004119",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "269859500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "592123944",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL GROUP ID",
            "identifier": "77940",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jim C Dickert, DO
• Kaitlyn Dickert, PA-C
• Ryan Spencer Dickert, MD
• Mark Allen Dietrich, MA
• Virginia Dohn
• Donald H Pritchard MD PA
• Joy A. Dowe, ARNP
• Dr Alexis Bergan-Guzman DC PA (Salve Center for Chiropractic and Wellness)
• Dr Michelle Zielecki DC PA
• Dr Thomas Myers and Associates LLC

• Cardiovascular Disease Physician in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.