Individual provider Active NPI

Jesus Garcia Dominguez, APRN

  • Nurse Practitioner
  • Hialeah, FL
National Provider Identifier
1891336079
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11004300 Issued in FL
Practice address
355 W 20TH St Apt 312
Hialeah, FL 33010-2553
Phone
(786) 371-7926
NPI assigned
Sep 30, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11004300 FL Primary

Addresses

Primary practice location

355 W 20TH St Apt 312
Hialeah, FL 33010-2553

Mailing address

355 W 20TH St Apt 312
Hialeah, FL 33010-2553
Phone (786) 371-7926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20210310001907 FL Practitioner - Nurse Practitioner 3678989902 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

1150 N 35TH Ave
Hollywood, FL 33021-5431
Phone (954) 265-7900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11004300FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Nov 13, 2020 Accepting new patients
South Broward Hospital District CurrentSince Nov 13, 2020 Accepting new patients
Luis F Tami PA CurrentSince Aug 10, 2024 Accepting new patients

Locations

20803 Biscayne Blvd
Ste 204
Aventura, FL 33180
Phone (954) 844-4480

1150 N 35th Ave
Ste 240
Hollywood, FL 33021
Phone (954) 362-3426

7777 Davie Road Ext
Ste 100B
Hollywood, FL 33024
Phone (954) 354-2600

1150 N 35th Ave
Ste 605
Hollywood, FL 33021
Phone (954) 965-2966

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1891336079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 W 20TH ST APT 312",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330102553",
            "telephone_number": "786-371-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 20TH ST APT 312",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330102553",
            "telephone_number": "786-371-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA DOMINGUEZ",
        "first_name": "JESUS",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11004300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.