Individual provider Active NPI

Jose Luis Dominguez, MD

  • Internal Medicine Physician
  • Snellville, GA
National Provider Identifier
1295835775
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36190 Issued in GA
Practice address
2121 Fountain Dr Ste a
Snellville, GA 30078-2900
Phone
(770) 736-3008
NPI assigned
Sep 24, 2006
Last updated
Oct 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36190 GA Primary

Addresses

Primary practice location

2121 Fountain Dr Ste a
Snellville, GA 30078-2900

Mailing address

2121 Fountain Dr Ste a
Snellville, GA 30078-2900
Phone (770) 736-3008

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
Premier Primary Care, LLCGroup PAC ID 4880936970, 2 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
76.43 of 100Reported as group
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

LicenseStateTypeSpecialty
36190GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Primary Care, LLC Internal Medicine CurrentSince Feb 25, 2019 Accepting new patients

Locations

2121 Fountain Dr
Ste A
Snellville, GA 30078
Phone (770) 736-3008

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EJHDAD
  • FHIR API: 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792022400000",
    "number": "1295835775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 FOUNTAIN DR STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782900",
            "telephone_number": "770-736-3008",
            "fax_number": "770-687-2296"
        },
        {
            "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": "2026-10-15",
        "certification_date": "2026-10-15",
        "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

Verify at the official NPI Registry.