Active NPI
Joan A Domengeaux, PT
- Physical Therapist
- Ft. Irwin, CA
National Provider Identifier
1891711941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 04173
- Practice address
- BLDG 166 4TH Street
Ft. Irwin, CA 92310 - Phone
- (760) 380-6862
- NPI assigned
- Jul 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 04173 | LA | Primary |
Addresses
Primary practice location
BLDG 166 4TH Street
Ft. Irwin, CA 92310
Mailing address
8109A Salerno St
Fort Irwin, CA 92310-2422
Phone (760) 386-2846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1800 1St Capitol Dr
Apt 1
Saint Charles, MO 63301-1660
Phone (636) 242-1764
9101 N Ambassador Dr
Kansas City, MO 64154-7295
Phone (816) 631-0847
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04173 | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| THPT, Inc | Physical Therapist | Past | Accepting new patients |
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.
-
- Multi-Specialty Clinic/Center
- Saint Charles, MO
- NPI 1417479494
-
- Multi-Specialty Clinic/Center
- Kansas City, MO
- NPI 1083208391
-
- Physical Therapist
- Honolulu, HI
- NPI 1619960275
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891711941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8109A SALERNO ST",
"city": "FORT IRWIN",
"state": "CA",
"postal_code": "923102422",
"telephone_number": "760-386-2846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG 166 4TH STREET",
"city": "FT. IRWIN",
"state": "CA",
"postal_code": "92310",
"telephone_number": "760-380-6862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMENGEAUX",
"first_name": "JOAN",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "04173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft. Irwin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.