Michele Domenick, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

D92021 Issued in MD

Practice address

500 Cadmus LN Ste 205
Easton, MD 21601-4094

Phone

(410) 822-4553

NPI assigned

Feb 17, 2006

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

Medicare fee-for-service enrollment

Enrolled in DE, MD2 enrollments

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 2

Specialty

General Surgery

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chester River Hospital CenterGroup PAC ID 0749220671, 28 clinicians

University of Maryland Community Medical Group IncGroup PAC ID 3678472214, 446 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of MD Shore Medical Ctr at Chestertown Hospital, Chestertown, MD, CCN 210030
• University of MD Shore Medical Center at Easton Hospital, Easton, MD, CCN 210037
• Bayhealth Medical Center, Kent Campus Hospital, Dover, DE, CCN 080004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdomenick829580@direct.umm.edu

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.

• Chester River Hospital Center

  • General Acute Care Hospital
  • Chestertown, MD
  • NPI 1679536809

  MD

  Medicare reassignment Care Compare group NPD
• University of Maryland Community Medical Group, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1477530624

  Family Medicine, MD

  Medicare reassignment Care Compare group NPD
• Surgical Associates PA

  • Surgery Physician
  • Dover, DE
  • NPI 1538115829

  DE, Surgery

  Medicare reassignment NPD
• Chester River Health Center

  • Clinic/Center
  • Chestertown, MD
  • NPI 1114290293
  NPD
• University of Maryland Community Medical Group, Inc.

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1679393854
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Chester River Hospital Center

  • General Acute Care Hospital
  • Chestertown, MD
  • NPI 1679536809

  Hospital

  Care Compare affiliation
• Shore Health System, Inc

  • General Acute Care Hospital
  • Cambridge, MD
  • NPI 1194784751

  Hospital

  Care Compare affiliation
• Shore Health System, Inc

  • Clinical Medical Laboratory
  • Easton, MD
  • NPI 1477513273

  Hospital

  Care Compare affiliation
• Shore Health System, Inc

  • General Acute Care Hospital
  • Easton, MD
  • NPI 1669431219

  Hospital

  Care Compare affiliation
• Bayhealth Medical Center, Inc.

  • General Acute Care Hospital
  • Dover, DE
  • NPI 1467546135

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1720052400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BANNING ST",
            "address_2": "SUITE 310",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043485",
            "telephone_number": "302-674-0600",
            "fax_number": "302-672-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CADMUS LN STE 205",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216014094",
            "telephone_number": "410-822-4553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Banning St",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "DE",
            "postal_code": "199043485",
            "country_code": "US",
            "telephone_number": "302-674-0600",
            "fax_number": "302-672-7144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMENICK",
        "first_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "DE",
            "license": "C1-0006569",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C1-0006569",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "D92021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis Thomas Divilio, M.D.
• Andrea Dixon
• Ann Dodge
• Terra Leigh Dodrill, BS
• Olivia Doller, AU.D.
• Christina Dorrian, DO
• Palak Doshi
• Mark P Downey, MD
• W James Downs Jr., PT PA
• Hannah Smith Doyle, PT, DPT

• All providers in Easton, MD
• Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.