Carlie Ann Dominguez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00904600 Issued in NJ

Practice address

201 Lyons Ave
Newark, NJ 07112-2027

Phone

(973) 886-8521

NPI assigned

Jan 7, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rwjbh Observation Associates LLCGroup PAC ID 5193137503, 995 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Rwjbh Observation Associates LLC

  • Emergency Medicine Physician
  • Livingston, NJ
  • NPI 1760095806
  Medicare reassignment Care Compare group
• Rwjbh Emergency Medicine Associates, LLC

  • Emergency Medicine Physician
  • Somerset, NJ
  • NPI 1912510041
  Medicare reassignment

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1881404440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 SUNSET DR",
            "city": "WHIPPANY",
            "state": "NJ",
            "postal_code": "079811620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 LYONS AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071122027",
            "telephone_number": "973-886-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "CARLIE",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00904600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yakisha S. Dodson, RRT
• Geoffrey Doerner, LCSW
• Vivian Doh-Altieri, LPN
• Craig William Dolan, PHARMD, RPH
• Vanessa Domingues
• Diana Dominguez, LSW
• Janicel Dominguez, APRN
• Donato a Colavita, MD PA
• Srikar Donepudi
• Mark A Donetz, ATC

• Physician Assistant in Newark, NJ
• Providers in Newark, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.