Dominion Diagnostics, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

00343 Issued in RI

Legal business name

DOMINION DIAGNOSTICS, LLC

Practice address

211 Circuit Drive
North Kingstown, RI 02852-7440

Phone

(877) 734-9600

Fax

(401) 667-0330

NPI assigned

Jun 27, 2005

Organization subpart

No

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

Authorized official

Name

Brandy Ellis

Title

Payer Relations Rep

Phone

(802) 734-6392

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in RI, VT2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Dominion Diagnostics, LLC

  • Clinical Medical Laboratory
  • Williston, VT
  • NPI 1831327170

  9335221852

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dominion Diagnostics, LLC

  • Clinical Medical Laboratory
  • Williston, VT
  • NPI 1831327170

  O20090528000480

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1912903717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CIRCUIT DRIVE",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028527440",
            "telephone_number": "877-734-9600",
            "fax_number": "401-667-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CIRCUIT DRIVE",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028527440",
            "telephone_number": "877-734-9600",
            "fax_number": "401-667-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "PAYER RELATIONS REP",
        "authorized_official_telephone_number": "802-734-6392"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "RI",
            "license": "00343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "49D0926092",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP AU-ID",
            "identifier": "1334975",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP LAP NUMBER",
            "identifier": "7029901",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diagnostic Evaluation Institute. LLC
• Nicholas Diaz, LMT
• Miranda Dicenzo, LMHCA
• Tiana Dickenson, LCSW (ELIGIBLE)
• William Digiuseppe
• Pamela Dooner, NP-C
• Kathleen Doyle
• Kelly Jane Doyle, LCMHC
• Dr. David G. Wright OD Inc
• Dr. Thomas F Vutech DMD, Fagd

• Clinical Medical Laboratory in North Kingstown, RI
• Providers in North Kingstown, RI by specialty
• Clinical Medical Laboratory in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.

Verify at the official NPI Registry.