Individual provider Active NPI

Lindsay Marie Domangue, PA

  • Physician Assistant
  • Shenandoah, TX
National Provider Identifier
1639486749
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06805 Issued in TX
Practice address
1120 Medical Plaza Dr
Ste 250B
Shenandoah, TX 77380-3242
Phone
(281) 296-8500
Fax
(281) 296-8591
NPI assigned
Sep 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA06805 TX Primary

Addresses

Primary practice location

1120 Medical Plaza Dr
Ste 250B
Shenandoah, TX 77380-3242

Mailing address

1120 Medical Plaza Dr
Ste 250B
Shenandoah, TX 77380-3242
Phone (281) 296-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20130823001166 TX Practitioner - Physician Assistant 8921241894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

10970 Shadow Creek Pkwy
Suite 100
Pearland, TX 77584-0166
Phone (281) 398-8500

134 Vision Park Blvd
Shenandoah, TX 77384-3032

7900 Fannin St
Suite 4000
Houston, TX 77054-2935
Phone (713) 512-7500

8215 Cypresswood Dr
Spring, TX 77379-7466
Phone (832) 717-0877

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group Gulf Coast, PLLC CurrentSince Oct 31, 2016 Accepting new patients
Privia Medical Group Gulf Coast PLLC CurrentSince Oct 31, 2016 Accepting new patients

Locations

7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027

10970 Shadow Creek Pkwy
Ste 100
Pearland, TX 77584
Phone (281) 398-8500

134 Vision Park Blvd
Ste 300
Shenandoah, TX 77384
Phone (281) 296-8500

17510 W Grand Pkwy S
Ste 430
Sugar Land, TX 77479
Phone (713) 578-3820

17450 St Lukes Way
Ste 290
The Woodlands, TX 77384
Phone (281) 296-8500

Interoperability endpoints

  • Direct secure messaging: lindsay.domangue.1@8042.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1639486749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 MEDICAL PLAZA DR",
            "address_2": "STE 250B",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773803242",
            "telephone_number": "281-296-8500",
            "fax_number": "281-296-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MEDICAL PLAZA DR",
            "address_2": "STE 250B",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773803242",
            "telephone_number": "281-296-8500",
            "fax_number": "281-296-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMANGUE",
        "first_name": "LINDSAY",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-10",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

Verify at the official NPI Registry.