Michael William Dominisse Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

5751 Edwards Ranch Rd Ste 101
Fort Worth, TX 76109-4131

Phone

(817) 923-8220

NPI assigned

Nov 5, 2017

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Molly M Warthan MDGroup PAC ID 7810203817, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Molly M Warthan MD

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1306228432
  Medicare reassignment Care Compare group
• Scott B Hearth, MD

  • Specialist
  • Roseville, CA
  • NPI 1871908277
  NPD (past)

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

{
    "created_epoch": "1509840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1962914580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CANYON CREEK CIR",
            "address_2": "CANYON CREEK CIRCLE",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760874039",
            "telephone_number": "916-402-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5751 EDWARDS RANCH RD STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094131",
            "telephone_number": "817-923-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINISSE",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-05",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Dombrowsky, PT
• Mia Dominguez- Hitchcock, LCDC, LMSW
• Allison Weber Dominguez, MS, RD, LD
• Estela M Dominguez, AAS
• Sarah Dominguez, LPC
• Domino Effects
• Ashley Domino
• Jerren Domino, DPT
• Cathryn Donaghey, M.S. SLP CFY
• Sherry Michelle Donahue-Brown

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; 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.
• 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.