Individual provider Active NPI

Dominick Joseph Acquaro, DO

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1366930737
Registry record updated Oct 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02006542A Issued in IN
Practice address
7806 W Jefferson Blvd Ste E
Fort Wayne, IN 46804-4180
Phone
(260) 459-0087
Fax
(260) 969-8514
NPI assigned
May 1, 2018
Last updated
Oct 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02006542A IN Primary

Addresses

Primary practice location

7806 W Jefferson Blvd Ste E
Fort Wayne, IN 46804-4180

Mailing address

7806 W Jefferson Blvd Ste E
Fort Wayne, IN 46804-4180
Phone (260) 459-0087

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20230302001853 IN Practitioner - Family PracticePractitioner - General PracticePractitioner - Osteopathic Manipulative Medicine 0749535458 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
Marian University College of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acquaro Medical Practice, PCGroup PAC ID 2163965948, 2 clinicians

Practice addresses (Care Compare)

7806 W Jefferson Blvd
Suite E
Fort Wayne, IN 46804-4180
Phone (260) 459-0087

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02006542AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acquaro Medical Practice, PC Family Medicine CurrentSince Apr 21, 2024 Accepting new patients

Locations

7806 W Jefferson Blvd
Ste E
Fort Wayne, IN 46804
Phone (260) 459-0087

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728777600000",
    "number": "1366930737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7806 W JEFFERSON BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044180",
            "telephone_number": "260-459-0087",
            "fax_number": "260-969-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7806 W JEFFERSON BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044180",
            "telephone_number": "260-459-0087",
            "fax_number": "260-969-8514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACQUARO",
        "first_name": "DOMINICK",
        "middle_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-01",
        "last_updated": "2024-10-13",
        "certification_date": "2024-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02006542A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.