NPIMap

Individual provider Active NPI

Lisette Dominguez, DO

  • Neurology Physician
  • Circleville, OH
National Provider Identifier
1578023842
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
34.017288 Issued in OH
Practice address
600 N Pickaway St Ste 200
Circleville, OH 43113-1447
Phone
(614) 533-5500
Fax
(614) 533-0103
NPI assigned
Mar 22, 2019
Last updated
Jul 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X UO6775 FL
Neurology Physician 2084N0400X UO6775 FL
Neurology Physician 2084N0400X OS17146 FL
Neurology Physician 2084N0400X 34.017288 OH Primary

Addresses

Primary practice location

600 N Pickaway St Ste 200
Circleville, OH 43113-1447

Mailing address

PO Box 7527
Dublin, OH 43017-0727

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ldominguez514142@ehrdirect.mayoclinicmsg.org
Direct Messaging Address ldominguez1093662@direct.ohiohealth.com OhioHealth Physician Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823001526 OH Practitioner - Neurology 7012242654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

600 N Pickaway St
Circleville, OH 43113-1447
Phone (614) 533-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.04 of 100Reported as group
Quality
58.67
Promoting interoperability
98
Improvement activities
40
Cost
76.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS17146FLMDNeurology Physician
UO6775FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Aug 1, 2024 Accepting new patients
Ohiohealth Corporation Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients

Locations

600 N Pickaway St
Ste 200
Circleville, OH 43113
Phone (740) 420-8526

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

Interoperability endpoints

  • Direct secure messaging: ldominguez514142@ehrdirect.mayoclinicmsg.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1578023842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7527",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430170727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N PICKAWAY ST STE 200",
            "city": "CIRCLEVILLE",
            "state": "OH",
            "postal_code": "431131447",
            "telephone_number": "614-533-5500",
            "fax_number": "614-533-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "LISETTE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "UO6775",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "UO6775",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "OS17146",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "34.017288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldominguez514142@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "4500 San Pablo Rd S",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322241865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldominguez1093662@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group, Inc.",
            "address_1": "600 N Pickaway St Ste 200",
            "city": "Circleville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "431131447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Circleville, OH

Sources for this page

Verify at the official NPI Registry.