Individual provider Active NPI

Dominic Klosowski, MD

  • Family Medicine Physician
  • Eugene, OR
National Provider Identifier
1265162168
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD224652 Issued in OR
Practice address
1835 Pearl Street
Eugene, OR 97401-8217
Phone
(541) 762-6050
Fax
(541) 762-6021
NPI assigned
Jun 14, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4351049991 MI
Family Medicine Physician 207Q00000X MD224652 OR Primary

Addresses

Primary practice location

1835 Pearl Street
Eugene, OR 97401-8217

Mailing address

PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119

Other practice location 1

3443 Farr Rd
Fruitport, MI 49415-8779
Phone (231) 672-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20250722003967 OR Practitioner - Family Practice 2860908258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

1835 Pearl St
Eugene, OR 97401-8217
Phone (541) 762-6050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4351049991MIMDFamily Medicine Physician
MD224652ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Jul 1, 2025 Accepting new patients
Praxis Health, PC Family Medicine CurrentSince Jul 1, 2025 Accepting new patients

Locations

1488 Oak St
Eugene, OR 97401
Phone (541) 431-0000

1835 Pearl St
Eugene, OR 97401
Phone (541) 687-1668

Interoperability endpoints

  • Direct secure messaging: pearlstreetmedical@praxismedicalgroup.directbygreenway.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1265162168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 PEARL STREET",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974018217",
            "telephone_number": "541-762-6050",
            "fax_number": "541-762-6021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3443 Farr Rd",
            "address_purpose": "LOCATION",
            "city": "Fruitport",
            "state": "MI",
            "postal_code": "494158779",
            "country_code": "US",
            "telephone_number": "231-672-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLOSOWSKI",
        "first_name": "DOMINIC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-14",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4351049991",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD224652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.