Dominic Prospero

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

31007611A Issued in IN

Practice address

53880 Carmichael Dr
South Bend, IN 46635-1567

Phone

(574) 247-9441

Fax

(574) 247-9442

NPI assigned

Apr 13, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Medicine Center of Northern Indiana IncGroup PAC ID 0840260105, 46 clinicians

Central Indiana Orthopedics LLCGroup PAC ID 5698667822, 148 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.81 of 100Reported as group

Quality

64.48

Promoting interoperability

96

Improvement activities

40

Cost

78.21

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Central Indiana Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Muncie, IN
  • NPI 1063422137

  IN, Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Orthopedic and Sports Medicine Center of Northern Indiana, Inc

  • Orthopaedic Surgery Physician
  • Elkhart, IN
  • NPI 1710085253

  IN

  Medicare reassignment Care Compare group NPD
• Central Indiana Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1669207023
  NPD
• Orthopedic and Sports Medicine Center of Northern Indiana, Inc

  • Durable Medical Equipment & Medical Supplies
  • Granger, IN
  • NPI 1962170357
  NPD
• ASC Surgical Ventures, LLC

  • Ambulatory Surgical Clinic/Center
  • Elkhart, IN
  • NPI 1083715148
  NPD (past)

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1851898076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W BETHEL AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473045407",
            "telephone_number": "800-622-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53880 CARMICHAEL DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351567",
            "telephone_number": "574-247-9441",
            "fax_number": "574-247-9442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60160 Bodnar Blvd",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465449338",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5230 Beck Dr Ste 7",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465169059",
            "country_code": "US",
            "telephone_number": "584-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROSPERO",
        "first_name": "DOMINIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-13",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056-012465",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31007611A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proactive Health, Inc
• Kristen Prock, MSW
• Professional Vision Inc
• Professional Vision Inc
• Elizabeth D. Progar, PA-C
• Diane Johnson Prosser, PH.D.
• Sierra Ann Proud
• Stephanie Ann Proudfoot, BCBA
• Jasmine Pruitt, RBT
• Samatha Pruitt, RBT

• Occupational Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.