Dominic Bogucki, ATC, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA064456 Issued in PA

Practice address

170 W Germantown Pike
Norristown, PA 19401-1389

Phone

(215) 605-3634

NPI assigned

Feb 6, 2017

Last updated

Dec 6, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142
• Jefferson Einstein Montgomery Hospital Hospital, East Norriton, PA, CCN 390329

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Einstein Practice Plan Inc

  dba Einstein Psychiatry Assoc

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1760434468
  Medicare reassignment Care Compare group
• Einstein Practice Plan Inc

  • Certified Registered Nurse Anesthetist
  • Philadelphia, PA
  • NPI 1457047433
  NPD
• Einstein Practice Plan Inc

  dba Einstein Regional Orthopaedic Specialists

  • Orthopaedic Surgery Physician
  • Philadelphia, PA
  • NPI 1477510154
  NPD
• Albert Einstein Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Phila, PA
  • NPI 1881798320
  NPD (past)
• Einstein Practice Plan Inc

  dba Northern Vascular Lab

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1992761621
  NPD (past)

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

• Einstein Hospital

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1366653818
  Care Compare affiliation Name & address match
• Einstein Medical Center Montgomery

  • General Acute Care Hospital
  • East Norriton, PA
  • NPI 1104192590
  Care Compare affiliation

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1265970669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 W GERMANTOWN PIKE",
            "city": "NORRISTOWN",
            "state": "PA",
            "postal_code": "194011389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 W GERMANTOWN PIKE",
            "city": "NORRISTOWN",
            "state": "PA",
            "postal_code": "194011389",
            "telephone_number": "215-605-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGUCKI",
        "first_name": "DOMINIC",
        "credential": "ATC, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA064456",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davida Block, CADC
• Blue Emerald Portfolios LLC (Catalyst Care LLC)
• Blythe Trucking LLC
• Sara Ann Boehret, M.S., A.T.C.
• Anna Boesteanu
• Alica N Boleware, M.A.
• Paige Elizabeth Boley, LPC
• Dominic J Bontempo, D.O.
• Sydney Boone, RN
• Kristen Martha Born, PA-C

• Surgical Physician Assistant in Norristown, PA
• Providers in Norristown, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.