NPIMap

Individual provider Active NPI

Martin Dominguez, M.D., PH.D.

  • Cardiovascular Disease Physician
  • Philadelphia, PA
National Provider Identifier
1861734188
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD474560 Issued in PA
Practice address
9501 Roosevelt Blvd Ste 501
Philadelphia, PA 19114-1030
Phone
(215) 673-5000
NPI assigned
Mar 25, 2013
Last updated
Apr 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD474560 PA Primary

Addresses

Primary practice location

9501 Roosevelt Blvd Ste 501
Philadelphia, PA 19114-1030

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-1324

Other practice location 1

525 E 68th St
New York, NY 10065-4870
Phone (203) 915-8064

Other practice location 2

824 Main St Ste 306
Phoenixville, PA 19460-4478
Phone (610) 983-1941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230630000882 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0941594717 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Yale University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians
Phoenixville Clinic Company LLCGroup PAC ID 5799796850, 135 clinicians

Practice addresses (Care Compare)

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 214-7875

824 Main St
Suite 306
Phoenixville, PA 19460-4478
Phone (610) 983-1530

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
141211CAMDMarriage & Family Therapist
MD474560PAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple Faculty Practice Plan Inc CurrentSince Dec 1, 2025 Accepting new patients
Phoenixville Clinic Company LLC CurrentSince Mar 1, 2024 Accepting new patients
Temple Faculty Practice Plan, Inc CurrentSince Dec 1, 2025 Accepting new patients
Phoenixville Clinic Company LLC Cardiovascular Disease CurrentSince Mar 1, 2024 Accepting new patients

Locations

3401 N Broad St
Philadelphia, PA 19140
Phone (215) 707-3807

3509 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2433

7600 Central Ave
Philadelphia, PA 19111
Phone (215) 707-5522

140 Nutt Rd
Phoenixville, PA 19460
Phone (610) 983-1000

824 Main St
Ste 306
Phoenixville, PA 19460
Phone (610) 644-7755

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1861734188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 ROOSEVELT BLVD STE 501",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141030",
            "telephone_number": "215-673-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E 68th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100654870",
            "country_code": "US",
            "telephone_number": "203-915-8064",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "824 Main St Ste 306",
            "address_purpose": "LOCATION",
            "city": "Phoenixville",
            "state": "PA",
            "postal_code": "194604478",
            "country_code": "US",
            "telephone_number": "610-983-1941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-25",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD474560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.