Teresa Domack, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

62215 Issued in CT

Practice address

21 South Rd Ste 110
Farmington, CT 06032

Phone

(860) 284-4945

Fax

(860) 284-4946

NPI assigned

May 12, 2014

Sex

Female

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 CT

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

Family PracticeAlso: Hospitalist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wheeler Clinic IncGroup PAC ID 0345147153, 105 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: teresa.domack.p1@direct.wheelerclinic.nextgenshare.com

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.

• Wheeler Clinic Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plainville, CT
  • NPI 1396750840
  Medicare reassignment Care Compare group
• Middlesex Hospital

  • Family Medicine Physician
  • Middletown, CT
  • NPI 1851350664
  Medicare reassignment NPD
• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053
  Medicare reassignment NPD

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553817600000",
    "number": "1235540386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 SOUTH RD STE 110",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322482",
            "telephone_number": "860-284-4945",
            "fax_number": "860-284-4946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 SOUTH RD STE 110",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "06032",
            "telephone_number": "860-284-4945",
            "fax_number": "860-284-4946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 South Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "06032",
            "country_code": "US",
            "telephone_number": "860-284-4945",
            "fax_number": "860-284-4946",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "90 S Main St",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "CT",
            "postal_code": "064573649",
            "country_code": "US",
            "telephone_number": "860-358-6418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMACK",
        "first_name": "TERESA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-12",
        "last_updated": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "62215",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "62215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Edward Dobson
• William Kennedy Doemland, MD
• Siobhan M Dolan, MD
• Jacob Scott Dolins, DO
• Vera Dolling-Engmann, LCSW
• Deborah Ann Dominguez, CRNA
• Anna Dongari-Bagtzoglou, D.D.S.
• David Donofrio, CCP
• Nathaniel Mark Donofrio, PA-C
• Elizabeth Joan Donovan, RN, APRN, FNP-C

• Family Medicine Physician in Farmington, CT
• Providers in Farmington, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; 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.