Individual provider Active NPI

Joanne Domingo, PA

  • Surgical Physician Assistant
  • New Hyde Park, NY
National Provider Identifier
1518179332
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
000682-1 Issued in NY
Practice address
2800 Marcus Ave
New Hyde Park, NY 11042-1008
Phone
(516) 622-6076
NPI assigned
May 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000682-1 NY
Surgical Physician Assistant 363AS0400X 000682-1 NY Primary

Addresses

Primary practice location

2800 Marcus Ave
New Hyde Park, NY 11042-1008

Mailing address

2800 Marcus Ave
New Hyde Park, NY 11042-1008
Phone (516) 622-6076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20131011000802 NY Practitioner - Physician Assistant 9931333606 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
72.13
Promoting interoperability
91
Improvement activities
40
Cost
75.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000682NYMDAcupuncturist
000682-1NYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Organizations & group practices 5

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": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1518179332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421008",
            "telephone_number": "516-622-6076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421008",
            "telephone_number": "516-622-6076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "JOANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "000682-1",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "000682-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

Verify at the official NPI Registry.