NPIMap

Individual provider Active NPI

Jeffrey Todd Domingue, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Sioux Falls, SD
National Provider Identifier
1962418178
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
237 Issued in SD
Practice address
2100 S Marion Rd
Sioux Falls, SD 57106-3646
Phone
(605) 322-5180
Fax
(605) 322-1301
NPI assigned
Jul 31, 2006
Last updated
Jul 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 682 CO
Foot & Ankle Surgery Podiatrist 213ES0103X 237 SD Primary

Addresses

Primary practice location

2100 S Marion Rd
Sioux Falls, SD 57106-3646

Mailing address

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 782-8305

Other names 1

  • Mr. Jeffrey Todd Domingue Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IA, MN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040826001160 SD Practitioner - Podiatry 6002881703 Reassigns benefits to 1 organization
I20191017001447 IA Practitioner - Podiatry 6002881703 Reassigns benefits to 1 organization
I20191031000850 MN Practitioner - Podiatry 6002881703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, shared by 52 NPIs, 957 clinicians

Practice addresses (Care Compare)

1200 1St Ave E
Spencer, IA 51301-4342

1202 21St Ave
Rock Valley, IA 51247-1420
Phone (712) 476-8000

4500 S Prince of Peace PL
Sioux Falls, SD 57103-5830
Phone (605) 322-5600

4513 S Prince of Peace PL
Sioux Falls, SD 57103-5830
Phone (605) 322-5600

6100 S Louise Ave
Sioux Falls, SD 57108-6029

901 E Virgil Ave
Milbank, SD 57252-2124
Phone (605) 432-4538

911 5TH Ave SW
Pipestone, MN 56164-1054
Phone (507) 825-5811

916 4TH Ave SW
Pipestone, MN 56164-1890
Phone (507) 825-6623

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions63
Removal of nail tissue2264
Removal or shaving of skin growth621

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
154SDMDCognitive & Behavioral Psychologist
1588TXMDProsthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Aug 1, 2019 Accepting new patients
Avera McKennan CurrentSince Sep 4, 2019 Accepting new patients
Avera McKennan CurrentSince Oct 1, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Aug 1, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Robert Neville & Associates PA Foot & Ankle Surgery Past Accepting new patients

Locations

1200 1st Ave E
Spencer, IA 51301
Phone (712) 264-6164

911 5th Ave SW
Pipestone, MN 56164
Phone (507) 825-5811

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

2100 S Marion Rd
Sioux Falls, SD 57106
Phone (605) 322-1010

911 E 20th St
Ste 300
Sioux Falls, SD 57105
Phone (605) 322-1300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JBDBCD
  • Direct secure messaging: jeffrey.domingue@avera.sdhealthlink.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1962418178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050900",
            "telephone_number": "605-782-8305",
            "fax_number": "605-336-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S MARION RD",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571063646",
            "telephone_number": "605-322-5180",
            "fax_number": "605-322-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUE",
        "first_name": "JEFFREY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CO",
            "license": "682",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SD",
            "license": "237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFFREY",
            "last_name": "DOMINGUE",
            "middle_name": "TODD",
            "prefix": "MR.",
            "credential": "DPM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.