NPIMap

Individual provider Active NPI

Amanda K Domingus, APRN

  • Family Nurse Practitioner
  • Rutland, VT
National Provider Identifier
1881209328
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
101.0134655 Issued in VT
Practice address
10 Commons St
Rutland, VT 05701-4651
Phone
(802) 747-3359
Fax
(802) 786-5204
NPI assigned
Sep 11, 2020
Last updated
Sep 28, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 101.0134655 VT Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

10 Commons St
Rutland, VT 05701-4651

Mailing address

10 Commons St
Rutland, VT 05701-4651
Phone (802) 747-3359

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20210414000620 VT Practitioner - Nurse Practitioner 1355759267 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Centers of the Rutland Region IncGroup PAC ID 2961467386, shared by 9 NPIs, 103 clinicians

Practice addresses (Care Compare)

275 Route 30 N
Bomoseen, VT 05732-9647
Phone (802) 468-5641

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
101.0134655VTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Rutland Region, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Community Health Centers of the Rutland Region, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Community Health Centers of the Rutland Region, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Community Health Centers of the Rutland Region, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Community Health Centers of the Rutland Region Inc Current Accepting new patients
Community Health Centers of the Rutland Region Inc CurrentSince Feb 1, 2024 Accepting new patients
Community Health Centers of the Rutland Region, Inc. CurrentSince Feb 1, 2024 Accepting new patients

Locations

275 VT 30 N
Bomoseen, VT 05732
Phone (802) 468-5641

420 Grove St
Brandon, VT 05733
Phone (802) 247-6305

1 General Wing Rd
Rutland, VT 05701
Phone (802) 773-9131

71 Allen St
Ste 402
Rutland, VT 05701
Phone (800) 468-9118

2987 Vt Route 22A
Shoreham, VT 05770
Phone (802) 897-7000

278 Vt Route 149
West Pawlet, VT 05775
Phone (800) 468-9118

Interoperability endpoints

  • Direct secure messaging: adomingus@chcrr.medentdirect.com

Organizations & group practices 7

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 11

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": "1599782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1881209328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 COMMONS ST",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014651",
            "telephone_number": "802-747-3359",
            "fax_number": "802-786-5204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 COMMONS ST",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014651",
            "telephone_number": "802-747-3359",
            "fax_number": "802-786-5204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUS",
        "first_name": "AMANDA",
        "middle_name": "K",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VT",
            "license": "101.0134655",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

Verify at the official NPI Registry.