Active NPI
Breanna Dominguez, MD
- Surgery Physician
- Dayton, OH
National Provider Identifier
1700467552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 57.253296
- Practice address
- 1 Wyoming St
Dayton, OH 45409-2722 - Phone
- (937) 208-8000
- NPI assigned
- Apr 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 57.253296 | OH | Primary |
Addresses
Primary practice location
1 Wyoming St
Dayton, OH 45409-2722
Mailing address
128 East Apple Street
Weber 7TH Floor
Dayton, OH 45409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220608001276 | OH | Order and Referring Only - General Surgery | 8729466479 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653523200000",
"number": "1700467552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 EAST APPLE STREET",
"address_2": "WEBER 7TH FLOOR",
"city": "DAYTON",
"state": "OH",
"postal_code": "45409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WYOMING ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454092722",
"telephone_number": "937-208-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "BREANNA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-14",
"last_updated": "2022-05-26",
"certification_date": "2022-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OH",
"license": "57.253296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.