NPIMap

Individual provider Active NPI

Dominique C D'Souza, MD

  • Family Medicine Physician
  • O'Fallon, IL
National Provider Identifier
1861078206
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.169372 Issued in IL
Practice address
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone
(618) 233-7880
NPI assigned
Mar 23, 2021
Last updated
Aug 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 036.169372 IL Primary
Internal Medicine Physician 207R00000X 036169372 IL
Hospitalist Physician 208M00000X 036169372 IL

Addresses

Primary practice location

3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284

Mailing address

3 Saint Elizabeth Blvd
O Fallon, IL 62269-1281
Phone (618) 233-5480

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
I20240822003253 IL Practitioner - HospitalistPractitioner - Family Practice 8729527700 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.169372ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-Illinois Hospitalists, LLP Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order Current Accepting new patients
St Elizabeths Hospital of the Hospital Sisters of the Third Order CurrentSince Jun 30, 2025 Accepting new patients
Cep America-Illinois Hospitalists Hospitalist CurrentSince Aug 1, 2024 Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine Current Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

Organizations & group practices 5

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 4

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1861078206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691281",
            "telephone_number": "618-233-5480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SAINT ELIZABETH BLVD STE 4000",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691284",
            "telephone_number": "618-233-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'SOUZA",
        "first_name": "DOMINIQUE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.169372",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036169372",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036169372",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.