NPIMap

Individual provider Active NPI

Peter M Dominick, PA-C

  • Physician Assistant
  • Albemarle, NC
National Provider Identifier
1639644198
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1007 N 6TH St
Albemarle, NC 28001-3551
Phone
(704) 982-8410
NPI assigned
Oct 10, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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 Primary

Addresses

Primary practice location

1007 N 6TH St
Albemarle, NC 28001-3551

Mailing address

531 E Farriss Ave
High Point, NC 27262-3254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20190115000710 NC Practitioner - Physician Assistant 2961748876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TLK Dermatology PLLCGroup PAC ID 6608313440, 16 clinicians

Practice addresses (Care Compare)

1007 N 6TH St
Albemarle, NC 28001-3551
Phone (704) 982-9410

360 Sunset Ave
Asheboro, NC 27203-5612
Phone (336) 625-8410

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
71.89 of 100Reported as individual
Quality
66.93
Improvement activities
40

National Provider Directory

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

Organizations & group practices 1

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 8

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539129600000",
    "number": "1639644198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 E FARRISS AVE",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272623254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N 6TH ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280013551",
            "telephone_number": "704-982-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINICK",
        "first_name": "PETER",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albemarle, NC

Sources for this page

Verify at the official NPI Registry.