Active NPI
Dominno Caroline Fogle, M.M.S., PA-C
- Medical Physician Assistant
- Deer Park, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 085004161
- Practice address
- 21660 W Field Pkwy
Deer Park, IL 60010-7265 - Phone
- (888) 803-3370
- NPI assigned
- Oct 7, 2011
- Last updated
- Jun 10, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 085004161 | IL | Primary |
Addresses
Primary practice location
21660 W Field Pkwy
Deer Park, IL 60010-7265
Mailing address
271 County Road 2325 E
Carlock, IL 61725-9020
Phone (815) 931-0244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carle Bromenn Medical Center | Current | Accepting new patients | |
| Carle Bromenn Medical Center | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Locations
2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461
1300 Franklin Ave
Ste 100
Normal, IL 61761
Phone (309) 268-3503
Organizations & group practices 4
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.
-
dba Bromenn Family Health Clinic
- Clinic/Center
- Normal, IL
- NPI 1104442615
-
- Family Medicine Physician
- Normal, IL
- NPI 1467074138
-
dba Advocate BroMenn Medical Center
- General Acute Care Hospital
- Normal, IL
- NPI 1962424036
-
dba Gibson Area Hospital and Health Services
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1255615365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "271 COUNTY ROAD 2325 E",
"city": "CARLOCK",
"state": "IL",
"postal_code": "617259020",
"telephone_number": "815-931-0244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21660 W FIELD PKWY",
"city": "DEER PARK",
"state": "IL",
"postal_code": "600107265",
"telephone_number": "888-803-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOGLE",
"first_name": "DOMINNO",
"middle_name": "CAROLINE",
"name_prefix": "Mrs.",
"credential": "M.M.S., PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-07",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IL",
"license": "085004161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.