Kathryn Marie Dominick, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036161559 Issued in IL

Practice address

1170 Fortune Blvd
Shiloh, IL 62269-7358

Phone

(618) 997-5266

Fax

(618) 997-5285

NPI assigned

May 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Osteopathic Manipulative MedicineAlso: Obstetrics/Gynecology

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heartland Women'S Healthcare LTDGroup PAC ID 1759270648, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
• Memorial Hospital Hospital, Belleville, IL, CCN 140185

Merit-based Incentive Payment System (MIPS)

Final score

82.36 of 100Reported as group

Quality

84.63

Improvement activities

40

Cost

55.93

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathryn.dominick.1@21608.direct.athenahealth.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.

• Heartland Women'S Healthcare LTD

  • Obstetrics & Gynecology Physician
  • Marion, IL
  • NPI 1851307532
  Medicare reassignment Care Compare group NPD
• Heartland Women'S Healthcare LTD

  • Clinical Medical Laboratory
  • Swansea, IL
  • NPI 1043852932
  NPD
• Heartland Women'S Healthcare Il PC

  • Obstetrics & Gynecology Physician
  • Shiloh, IL
  • NPI 1568057131
  NPD (past)

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

• Protestant Memorial Medical Center, Inc.

  • General Acute Care Hospital
  • Belleville, IL
  • NPI 1982796181
  Care Compare affiliation
• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302
  Care Compare affiliation

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1437640901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697358",
            "telephone_number": "618-997-5266",
            "fax_number": "618-997-5285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Oakland Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490081282",
            "country_code": "US",
            "telephone_number": "269-337-4472",
            "fax_number": "269-337-4234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINICK",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5151011654",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036161559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Depaulo, M.D.
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• Robert J Dizes Jr., PA-C
• Amy Lynn Dossett, PT
• Deryl Wayne Drum, DDS
• Bertram E Drury, M.D.
• Julia Dungan, MA, CCC, SLP
• Earth Water Air Counseling, LLC

• Obstetrics & Gynecology Physician in Shiloh, IL
• Providers in Shiloh, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; 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.