Active NPI
Lourdes M Dominguez, M.D.
- Psychiatry Physician
- New York, NY
National Provider Identifier
1932143369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 171839
- Practice address
- Allen Pavilion 3 River East
5141 Broadway
New York, NY 10034 - Phone
- (212) 932-4165
- Fax
- (212) 932-5369
- NPI assigned
- Jun 15, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 171839 | NY | Primary |
Addresses
Primary practice location
Allen Pavilion 3 River East
5141 Broadway
New York, NY 10034
Mailing address
Dept of Psychiatry, Trustees of Columbia University
622 West 168TH Street, Box 260
New York, NY 10032
Phone (212) 305-2330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01589844 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 12, 2020 through Oct 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of Columbia University in Department of Psychiatry | Psychiatry | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
Organizations & group practices 1
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.
-
- Psychiatry Physician
- New York, NY
- NPI 1619911526
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932143369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT OF PSYCHIATRY, TRUSTEES OF COLUMBIA UNIVERSITY",
"address_2": "622 WEST 168TH STREET, BOX 260",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10032",
"telephone_number": "212-305-2330",
"fax_number": "212-305-4724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ALLEN PAVILION 3 RIVER EAST",
"address_2": "5141 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10034",
"telephone_number": "212-932-4165",
"fax_number": "212-932-5369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINGUEZ",
"first_name": "LOURDES",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "171839",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01589844",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
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; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.