Kevin Anthony Domingos, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6878 Issued in MA

Practice address

1854 River St
Boston, MA 02136-1419

Phone

(617) 364-4465

Fax

(617) 364-5425

NPI assigned

Nov 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boston Neuropsychological Services LLCGroup PAC ID 2668538794, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Boston Neuropsychological Services, LLC

  • Clinical Neuropsychologist
  • Needham, MA
  • NPI 1407048432
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1162598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770662173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1854 RIVER ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021361419",
            "telephone_number": "617-364-4465",
            "fax_number": "617-364-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1854 RIVER ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021361419",
            "telephone_number": "617-364-4465",
            "fax_number": "617-364-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGOS",
        "first_name": "KEVIN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MA",
            "license": "6878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0524689",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard John Domenico, LICSW
• Kwaku Owusu Domfe, MD
• Ibrahim J Domian, MD PHD
• Dyanna Domilici, M.D.
• Erica Domingo
• Carla Dominguez Gonzalez, MD
• Megan Dominguez, PHARM.D, RPH
• Laura S Dominici, M.D.
• Patricia Dominique, NP
• Erica Dommasch, MD

• Clinical Neuropsychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Neuropsychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.