Active NPI
Dominique Richard
- Athletic Trainer
- Zachary, LA
National Provider Identifier
1386013290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 3429 Jersey Dr
Zachary, LA 70791-4209 - Phone
- (225) 636-6367
- NPI assigned
- Sep 21, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
3429 Jersey Dr
Zachary, LA 70791-4209
Mailing address
3429 Jersey Dr
Zachary, LA 70791-4209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221103001161 | GA | Practitioner - Physical Therapist in Private Practice | 5799152757 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Fox Rehabilitation Ga, LLC
Practice addresses (Care Compare)
Duluth, GA 30097
Phone (877) 407-3422
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehabilitation Ga, LLC | Current | Accepting new patients |
Locations
7 Carnegie Plz
Cherry Hill, NJ 08003
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442793600000",
"number": "1386013290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3429 JERSEY DR",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707914209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3429 JERSEY DR",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707914209",
"telephone_number": "225-636-6367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARD",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-21",
"last_updated": "2015-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zachary, LA
- Restore Counseling Services
- Restoring Lives Outreach Inc
- Lea K Rettig, M.S., L-SLP, CCC-SLP
- Mark Ryan Reynaud, MA, LPC, LMFT
- Brandon Richard, PT, DPT, CSCS, KTCC
- Matthew Richardson, CRNA
- Ann Marie Riley, BSN, RNC-MNN
- Rise Behavioral Services LLC
- Rise Career Services & Leadership Development, LLC
- Lauren Brunson Rivet, LOTR CHT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.