Jacqueline D Dominick, CRNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R097460 Issued in MD

Practice address

301 Hospital Dr
Glen Burnie, MD 21061-5803

Phone

(410) 787-4000

NPI assigned

Nov 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MD

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

Nurse Practitioner

Education

University of Maryland School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Maryland Baltimore Washington Heart Associates LLCGroup PAC ID 8729339148, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of MD Baltimore Washington Medical Center Hospital, Glen Burnie, MD, CCN 210043

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdominick21020@direct.umm.edu

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.

• University of Maryland Baltimore Washington Heart Associates LLC

  • Cardiovascular Disease Physician
  • Glen Burnie, MD
  • NPI 1972084507
  Medicare reassignment Care Compare group NPD
• Baltimore Washington Medical Center Inc.

  • General Acute Care Hospital
  • Glen Burnie, MD
  • NPI 1124016696
  Medicare reassignment NPD
• University of Maryland Community Medical Group, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1477530624
  Medicare reassignment NPD
• Baltimore Washington Medical Center Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Glen Burnie, MD
  • NPI 1740469774
  NPD
• Baltimore Washington Medical Center Inc.

  • Internal Medicine Physician
  • Glen Burnie, MD
  • NPI 1831378868
  NPD
• Baltimore Washington Medical Center Inc.

  • Customized Equipment (DME)
  • Glen Burnie, MD
  • NPI 1881799344
  NPD
• University of Maryland Community Medical Group, Inc.

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1679393854
  NPD
• Arundel Physicians Associates, LLC

  • Internal Medicine Physician
  • Millersville, MD
  • NPI 1396762274
  NPD (past)

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

• Baltimore Washington Medical Center Inc.

  • General Acute Care Hospital
  • Glen Burnie, MD
  • NPI 1124016696
  Care Compare affiliation

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196640000000",
    "number": "1366424921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HOSPITAL DR",
            "address_2": "SUITE 215",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616902",
            "telephone_number": "410-787-4000",
            "fax_number": "410-787-4846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-787-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINICK",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2007-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R097460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRAVO/ELDER HEALTH",
            "identifier": "4457",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHNS HOPKINS HEALTH CARE",
            "identifier": "127573",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408588400",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE FIRST BLUE CROSS",
            "identifier": "F591-0020",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE FIRST BLUE CROSS",
            "identifier": "64696401",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raphael Dodoo, M.D.
• Sang Cheol Doh, M.D.
• John Dolan, RPH
• Rochel Dombroff, PAC
• Bridget Furdon Dombrowski, MS, LCPC, LMHC
• Jennifer L Donaldson, CSC-AD
• Meaghan Donello, LCSW-C
• Melissa Donelson, CRNP
• Theresa Siobhan Donohue, LCPC
• Liam Donovan, CRNP-PMH

• Acute Care Nurse Practitioner in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Acute Care Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; 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.