Michael Glenn Domina, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

5095 Issued in TN

Practice address

740 Middle Creek Rd Ste 200
Sevierville, TN 37862-5056

Phone

(865) 908-9888

NPI assigned

Apr 2, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OR, TN, WI, TX4 enrollments

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 4

Specialty

Obstetrics/Gynecology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Obhg Texas Holdings PAGroup PAC ID 3577713072, 176 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdomina303555@samhealth.direct-ci.com
• Direct secure messaging: michael.domina@tn046.digichart.direct-ci.com

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.

• Obhg Texas Holdings, P.a.

  • Obstetrics & Gynecology Physician
  • Austin, TX
  • NPI 1083917769
  Medicare reassignment Care Compare group NPD
• Fort Sanders Perinatal Center

  • Maternal & Fetal Medicine Physician
  • Knoxville, TN
  • NPI 1003811381
  Medicare reassignment NPD
• Columbia St. Mary'S Hospital Milwaukee, Inc

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1023064482
  Medicare reassignment NPD
• Samaritan Pacific Health Services, Inc

  • Critical Access Hospital
  • Newport, OR
  • NPI 1801847066
  Medicare reassignment NPD
• Leconte Women'S Healthcare Associates, PC

  • Obstetrics & Gynecology Physician
  • Sevierville, TN
  • NPI 1053347492
  NPD
• Columbia St. Mary'S Hospital Milwaukee Inc

  • Psychiatric Hospital Unit
  • Mequon, WI
  • NPI 1417600909
  NPD
• Mid-Valley Healthcare, Inc.

  • Rural Health Clinic/Center
  • Lebanon, OR
  • NPI 1003182601
  NPD (past)

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1396130613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 SOUTH TULANE AVENUE",
            "address_2": "5303",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "37830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 MIDDLE CREEK RD STE 200",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378625056",
            "telephone_number": "865-908-9888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 W Park Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603805",
            "country_code": "US",
            "telephone_number": "423-224-3220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 SW Abbey St Ste B",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "OR",
            "postal_code": "973654820",
            "country_code": "US",
            "telephone_number": "541-574-7235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18511 Highlander Medics St",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799065327",
            "country_code": "US",
            "telephone_number": "915-742-1277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "675 N 5th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "OR",
            "postal_code": "973552875",
            "country_code": "US",
            "telephone_number": "541-451-6282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINA",
        "first_name": "MICHAEL",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OR",
            "license": "DO213625",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ME",
            "license": "DO3503",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ME",
            "license": "LT22012",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NE",
            "license": "1630",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TN",
            "license": "5095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q083566",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdomina251881@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "930 SW Abbey St Ste B",
            "city": "Newport",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973654820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdomina303555@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "675 N 5th St Ste 200",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973552875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Sevierville, TN
• Providers in Sevierville, TN by specialty
• Obstetrics & Gynecology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; 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.