Dominic Damian Freeburg, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

6781 Issued in AZ

Practice address

6750 E Baywood Ave # 503
Mesa, AZ 85206-1749

Phone

(712) 389-2418

NPI assigned

Dec 29, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Physician Specialists Arizona LLCGroup PAC ID 6204002272, 371 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Heart Hospital Hospital, Mesa, AZ, CCN 030105
• Banner Baywood Medical Center Hospital, Mesa, AZ, CCN 030088

Merit-based Incentive Payment System (MIPS)

Final score

84.12 of 100Reported as group

Quality

76.35

Promoting interoperability

99

Improvement activities

40

Cost

71.55

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1821368218
  Medicare reassignment Care Compare group NPD
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1316228802
  NPD
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Page, AZ
  • NPI 1366799355
  NPD

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

• Banner Baywood Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1194758284
  Care Compare affiliation
• Banner Heart Hospital

  • Special Hospital
  • Mesa, AZ
  • NPI 1215961248
  Care Compare affiliation

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1407211808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 E BAYWOOD AVE # 503",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061749",
            "telephone_number": "712-389-2418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 E BAYWOOD AVE # 503",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061749",
            "telephone_number": "712-389-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEBURG",
        "first_name": "DOMINIC",
        "middle_name": "DAMIAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-29",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "6781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Lee Frederickson, SLP
• Traci Frederickson, LMSW
• Jill Annette Fredrickson
• Free Life Wellness Center LLC
• Free Spirit Hospice Inc
• Lewis H Freed, DPM
• Kari L Freedland Coelho, PSYD
• Lee A Freedle
• Ashley Sell Freedman, DPT
• Freedom Az, LLC

• Surgical Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.