Active NPI
Jose Luis Dominguez, MD
- Internal Medicine Physician
- Snellville, GA
National Provider Identifier
1295835775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 36190
- Practice address
- 2121 Fountain Dr Ste a
Snellville, GA 30078-2900 - Phone
- (770) 736-3008
- NPI assigned
- Sep 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 36190 | GA | Primary |
Addresses
Primary practice location
2121 Fountain Dr Ste a
Snellville, GA 30078-2900
Mailing address
4517 Lavista Rd
Tucker, GA 30084-4208
Phone (770) 723-1226
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110404000822 | GA | Practitioner - Internal Medicine | 6709060403 |
Reassigns benefits to 1 organization Practice locations: Fort Benning, GA |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physiotherapy Associates Inc
Practice addresses (Care Compare)
2121 Fountain Dr
Suite a
Snellville, GA 30078-2900
Phone (770) 736-3008
966 A Killian Hill Rd SW
Lilburn, GA 30047-3102
Phone (770) 923-4815
Hospital & facility affiliations
- Central Home Health Care, an Amedisys Company
- Accentcare Home Health of Northeast Georgia
- Piedmont Eastside Medical Center
- Northside Hospital Gwinnett
- Northside Hospital Forsyth
- Emory Decatur Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 76.43 of 100
- Quality
- 63.31
- Improvement activities
- 40
- Cost
- 70.35
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36190 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Primary Care, LLC | Internal Medicine | Current | Accepting new patients |
Locations
2121 Fountain Dr
Ste A
Snellville, GA 30078
Phone (770) 736-3008
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EJHDAD
- https://fhir4.healow.com/fhir/r4/JFEICA
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Snellville, GA
- NPI 1154887925
GA, Internal Medicine
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Tucker, GA
- NPI 1477501179
-
- Home Health Agency
- Buford, GA
- NPI 1639100985
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555286400000",
"number": "1295835775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4517 LAVISTA RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844208",
"telephone_number": "770-723-1226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 FOUNTAIN DR STE A",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300782900",
"telephone_number": "770-736-3008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "JOSE",
"middle_name": "LUIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-24",
"last_updated": "2019-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "36190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snellville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.