Organization Active NPI

Dominick All-Heart Wellness Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Durango, CO
National Provider Identifier
1609417443
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DOMINICK ALL-HEART WELLNESS CENTER
Practice address
72 Suttle St Ste B
Durango, CO 81303-6829
Phone
(970) 444-2429
NPI assigned
Oct 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Authorized official

Name
Joanna Dominick, DNP, FNP-CNPI 1174788145
Title
Owner
Phone
(970) 444-2429

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

72 Suttle St Ste B
Durango, CO 81303-6829

Mailing address

72 Suttle St Ste B
Durango, CO 81303-6829
Phone (970) 444-2429

Other names 1

  • Dominick All-Heart Wellness Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL practicefusion.com Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191211002580 CO Part B Supplier - Clinic/Group Practice 4183057706 Receives reassigned benefits from 1 practitioner
Practice locations: Durango, CO

National Provider Directory

National Provider Directory

Locations

72 Suttle St
Ste B
Durango, CO 81303
Phone (970) 375-2465

1800 E 3rd Ave
Ste 112
Durango, CO 81301
Phone (970) 247-1120

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1609417443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST STE B",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-444-2429",
            "fax_number": "620-647-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST STE B",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-444-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINICK ALL-HEART WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "DOMINICK",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-444-2429",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "electronic health records",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EHR",
            "address_1": "1800 E 3rd Ave Ste 112",
            "city": "Durango",
            "state": "CO",
            "country_code": "US",
            "postal_code": "813015046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dominick All-Heart Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dominick All-Heart Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.