NPIMap

Individual provider Active NPI

Laura Marie Dominguez, MD

  • Otolaryngology Physician
  • Southlake, TX
National Provider Identifier
1649407925
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
P9329 Issued in TX
Practice address
300 S Nolen Dr Ste 100
Southlake, TX 76092-8057
Phone
(817) 989-2400
NPI assigned
Jun 15, 2009
Last updated
Nov 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X P9329 TX Primary

Addresses

Primary practice location

300 S Nolen Dr Ste 100
Southlake, TX 76092-8057

Mailing address

300 S Nolen Dr Ste 100
Southlake, TX 76092-8057
Phone (817) 989-2400

Other identifiers 2

IdentifierTypeStateIssuer
336345901MedicaidTX
336345902OtherTXCSHCN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140715002257 TX Practitioner - Otolaryngology 0143469502 Reassigns benefits to 2 organizations
I20200605001775 FL Practitioner - Otolaryngology 0143469502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Texas Medical School at San Antonio, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The ENT and Allergy Centers of Texas, PLLCGroup PAC ID 4385709054, 56 clinicians

Practice addresses (Care Compare)

300 S Nolen Dr
100 Southlake
Southlake, TX 76092-8057
Phone (817) 989-2400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.26 of 100Reported as apm
Quality
80.2
Promoting interoperability
99.24
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P9329TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The ENT & Allergy Centers of Texas, PLLC Otolaryngology CurrentSince Aug 1, 2024 Accepting new patients
Cleveland Clinic Florida a Nonprofit Corporation CurrentSince Jun 29, 2020 Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince Jul 1, 2014 Accepting new patients
University of Texas Health Science Center at San Antonio CurrentSince Jul 1, 2014 Accepting new patients
University of Texas Health Science Center at San Antonio Current Accepting new patients
Richard D Thrasher III MD PA Otolaryngology Past Accepting new patients

Locations

2950 Cleveland Clinic Blvd
Weston, FL 33331
Phone (954) 689-5000

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

5220 W University Dr
Ste 150
McKinney, TX 75071
Phone (972) 632-3270

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

8300 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-9300

8300 Floyd Curl Dr
Fl 6
San Antonio, TX 78229
Phone (210) 450-9400

300 S Nolen Dr
Ste 100
Southlake, TX 76092
Phone (817) 410-7777

Organizations & group practices 6

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 2

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": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1649407925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S NOLEN DR STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928057",
            "telephone_number": "817-989-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S NOLEN DR STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928057",
            "telephone_number": "817-989-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "P9329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336345901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "336345902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.