Active NPI
Jorge E. Dominguez MD PA
Doing business as Brownsville Pediatric & Adolescent Care
- Pediatrics Physician
- Brownsville, TX
National Provider Identifier
1629146873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- JORGE E. DOMINGUEZ MD PA
- Doing business as
- Brownsville Pediatric & Adolescent Care
- Practice address
- 3150 International Blvd
Brownsville, TX 78521-3214 - Phone
- (956) 548-1100
- Fax
- (956) 504-1907
- NPI assigned
- Dec 4, 2006
- Last updated
- May 26, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sylvia R Dominguez
- Title
- Administrator
- Phone
- (956) 548-1100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NU | Primary |
Addresses
Primary practice location
3150 International Blvd
Brownsville, TX 78521-3214
Mailing address
3150 International Blvd
Brownsville, TX 78521-3214
Phone (956) 548-1100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08490101.02 | Medicaid | TX | |
| 091753602 | Medicaid | TX | |
| 1538208038 | Medicaid | TX | |
| 084901001 | Medicaid | TX |
Other names 1
- Brownsville Pediatric & Adolescent Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0503518 | Brownsville Pediatric and Adolescent Care | Certificate of waiver | Jan 8, 2028 |
National Provider Directory
National Provider DirectoryInteroperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72228
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatrics Physician
- San Antonio, TX
- NPI 1679501787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1274832000000",
"number": "1629146873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 INTERNATIONAL BLVD",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785213214",
"telephone_number": "956-548-1100",
"fax_number": "956-504-1907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 INTERNATIONAL BLVD",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785213214",
"telephone_number": "956-548-1100",
"fax_number": "956-504-1907"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JORGE E. DOMINGUEZ MD PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-04",
"last_updated": "2010-05-26",
"status": "A",
"authorized_official_last_name": "DOMINGUEZ",
"authorized_official_first_name": "SYLVIA",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "956-548-1100"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08490101.02",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "091753602",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1538208038",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "084901001",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Brownsville Pediatric & Adolescent Care",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Brownsville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.