NPIMap

Individual provider Active NPI

Dominic James Kiomento, MD

  • Family Medicine Physician
  • Cadillac, MI
National Provider Identifier
1871573667
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301086808 Issued in MI
Practice address
8950 Professional Dr
Cadillac, MI 49601-8599
Phone
(231) 775-2493
Fax
(231) 775-2570
NPI assigned
Jan 19, 2006
Last updated
Mar 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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 4301086808 MI Primary

Addresses

Primary practice location

8950 Professional Dr
Cadillac, MI 49601-8599

Mailing address

8950 Professional Dr
Cadillac, MI 49601-8599
Phone (231) 775-2493

Other identifiers 5

IdentifierTypeStateIssuer
080H310080OtherMIBC BILLING NUMBER
4798746MedicaidMI
4798746OtherMIMOLINA BILLING NUMBER
141754OtherMIPREF CHOICE BILLING
DK086808OtherMISTATE LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20051117000909 MI Practitioner - Family Practice 6507851029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cadillac Family Physicians, P.C.Group PAC ID 2264405612, 8 clinicians

Practice addresses (Care Compare)

8950 Professional Dr
Cadillac, MI 49601-8599
Phone (231) 775-2493

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301086808MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cadillac Family Physicians, P.C. CurrentSince Nov 29, 2010 Accepting new patients
Wexford Medical Group Family Medicine Past Accepting new patients

Locations

8950 Professional Dr
Cadillac, MI 49601
Phone (231) 775-2493

Interoperability endpoints

  • Direct secure messaging: dominickiomento@cfp.allscriptsdirect.net

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 6

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1871573667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8950 PROFESSIONAL DR",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018599",
            "telephone_number": "231-775-2493",
            "fax_number": "231-779-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 PROFESSIONAL DR",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018599",
            "telephone_number": "231-775-2493",
            "fax_number": "231-775-2570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIOMENTO",
        "first_name": "DOMINIC",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301086808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BILLING NUMBER",
            "identifier": "080H310080",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4798746",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA BILLING NUMBER",
            "identifier": "4798746",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREF CHOICE BILLING",
            "identifier": "141754",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "DK086808",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cadillac, MI

Sources for this page

Verify at the official NPI Registry.