Moises B. Domingo

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

01032966 Issued in IN

Practice address

20 Hospital Dr
Harrisburg, IL 62946-2453

Phone

(618) 252-5126

Fax

(618) 252-0135

NPI assigned

Feb 13, 2006

Last updated

Sep 15, 2008By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Harrisburg Cancer Center Inc

  • Radiation Oncology Physician
  • Harrisburg, IL
  • NPI 1972553550
  NPD (past)

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221436800000",
    "number": "1609840248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15040",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477160040",
            "telephone_number": "812-476-1367",
            "fax_number": "812-477-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HOSPITAL DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462453",
            "telephone_number": "618-252-5126",
            "fax_number": "618-252-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "MOISES",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2008-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IN",
            "license": "01032966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036066172",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100319850",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty 303 Commercial St)
• Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty Express 716 Commercial St)
• Deaconess Regional Healthcare Services Illinois Inc (Deaconess Regional Transport and Logistics LLC)
• Leanne H Deneal, PA-C
• D. Tyler Dennison, D.C,
• Dr. Michael J. Gearing D.D.S. Inc
• Egyptian Health Department
• Egyptian Health Department
• Egyptian Health Department
• Ellet Pharmacy Inc (Medicap Pharmacy)

• Radiation Oncology Physician in Harrisburg, IL
• Providers in Harrisburg, IL by specialty
• Radiation Oncology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.