NPIMap

Individual provider Active NPI

Erin Beth Dominiak, M.D.

  • Family Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1740486489
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-118378 Issued in IL
Practice address
1610 Luther LN
Park Ridge, IL 60068-1243
Phone
(847) 318-2303
NPI assigned
Jun 21, 2007
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-118378 IL Primary

Addresses

Primary practice location

1610 Luther LN
Park Ridge, IL 60068-1243

Mailing address

1610 Luther LN
Amg - Adult Down Syndrome Center
Park Ridge, IL 60068-1243
Phone (847) 318-2303

Other identifiers 1

IdentifierTypeStateIssuer
036-118378OtherILPHYSICIAN LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address edominiak206459@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070810000452 IL Practitioner - Family Practice 1456442011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1775 Ballard Rd
Park Ridge, IL 60068-1005
Phone (847) 318-9368

1775 Dempster St
Park Ridge, IL 60068-1143

1775 W Ballard Rd
Geriatrics
Park Ridge, IL 60068-1005
Phone (847) 318-2500

1999 Dempster St
Park Ridge, IL 60068-1156
Phone (847) 318-2303

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

486 Randall Rd
Unit B
South Elgin, IL 60177-3354
Phone (224) 783-5000

665 Busse Hwy
Park Ridge, IL 60068-2523
Phone (847) 825-5517

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-118378ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Sep 1, 2007 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Sep 1, 2007 Accepting new patients

Locations

135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

1610 Luther Ln
Park Ridge, IL 60068
Phone (847) 318-2303

Interoperability endpoints

  • Direct secure messaging: edominiak206459@direct.myadvocateaurora.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Park Ridge Healthcare CenterPark Ridge, IL, CCN 145839 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2022
Jun 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 10

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": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1740486489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 LUTHER LN",
            "address_2": "AMG - ADULT DOWN SYNDROME CENTER",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681243",
            "telephone_number": "847-318-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 LUTHER LN",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681243",
            "telephone_number": "847-318-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIAK",
        "first_name": "ERIN",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-118378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN LICENSE",
            "identifier": "036-118378",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edominiak206459@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1610 Luther Ln",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.