Ma Portia Bernadette Guce Domingo, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036182000 Issued in IL

Practice address

1701 E College Ave
Bloomington, IL 61704-2101

Phone

(309) 664-3000

NPI assigned

Apr 19, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Phoebe Domingo Other name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: mdomingo35837@skagit.direct-ci.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1700573722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E COLLEGE AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E COLLEGE AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042101",
            "telephone_number": "309-664-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "819 S 13th St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982744112",
            "country_code": "US",
            "telephone_number": "360-814-6230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGO",
        "first_name": "MA PORTIA BERNADETTE",
        "middle_name": "GUCE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036182000",
            "primary": true
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IL",
            "license": "036182000",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "OL61440780",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHOEBE",
            "last_name": "DOMINGO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Daniel Dodd, PH.D.
• Venkata Ranganadh Dodda, MD
• Kevin Dodge
• Candice Dohman
• Amanda Doman, AA,CADC
• Hannah K Donahue, APN
• Kyle Donahue
• Sarah K Dooley
• Ava M Doran
• Julie R Dostal, RD,CDE

• Family Medicine Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; 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.

Verify at the official NPI Registry.