Brian Dominic, CADC-DP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2594 Springvale Rd
Boyne Falls, MI 49713-9684

Phone

(231) 535-2822

NPI assigned

Dec 1, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21307/brand/1/csg/1/fhir/r4

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.

• Bear River Primary Care

  • Family Medicine Physician
  • Gaylord, MI
  • NPI 1609427541
  NPD
• Walloon Lake Recovery Lodge, LLC

  • Substance Abuse Rehabilitation Facility
  • Boyne Falls, MI
  • NPI 1750791505
  NPD

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1942968540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2329 CENTER ST",
            "city": "BOYNE FALLS",
            "state": "MI",
            "postal_code": "497139268",
            "telephone_number": "231-535-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2594 SPRINGVALE RD",
            "city": "BOYNE FALLS",
            "state": "MI",
            "postal_code": "497139684",
            "telephone_number": "231-535-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIC",
        "first_name": "BRIAN",
        "credential": "CADC-DP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Andrews, LLPC
• Bear River Health
• Boyne Valley Township
• Ryan Bretz, CADC-DP
• Kari Day
• Rachel Eckenrod, BS, CADC-DP
• Gretchen Fontichiaro, CAADC-DP, MA COUNSEL
• Chris Frasz
• Katrina Freistatter, CADC
• Genevieve Carol Groover, LLMSW

• Addiction (Substance Use Disorder) Counselor in Boyne Falls, MI
• Providers in Boyne Falls, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.