Angel L Dominguez, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26733 Issued in MN

Practice address

301 2ND St NE
New Prague, MN 56071-1709

Phone

(952) 758-4431

NPI assigned

Aug 21, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mayo Clinic Health System-Fairmont

  • Multi-Specialty Clinic/Center
  • Fairmont, MN
  • NPI 1366410862
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Critical Access Hospital
  • New Prague, MN
  • NPI 1124035282
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • New Prague, MN
  • NPI 1477089407
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1891579827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 2ND ST NE",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560711709",
            "telephone_number": "952-758-4431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 E River Dr Ste 330",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528035761",
            "country_code": "US",
            "telephone_number": "563-424-0136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "ANGEL",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-21",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "26733",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "082177",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adominguez133076@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "301 2nd St NE",
            "city": "New Prague",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560711709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jill Elizabeth Companion
• Jean E Craig, MD
• David R. Dare, M.D.
• Dental on First
• Alice Freda Doll, OTR
• Dragonfly Children'S Respite Home Inc.
• Benjamin Dresow, PHARMD
• Drug Express Pharmacies Inc
• Gregory Raymond Dvorak, DDS
• Edina Eye Physicians and Surgeons PA

• Clinical Social Worker in New Prague, MN
• Providers in New Prague, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.