Dominic Mason Etli, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN002559 Issued in NV

Practice address

540 N Nellis Blvd
Las Vegas, NV 89110-5368

Phone

(702) 877-5199

NPI assigned

Mar 30, 2017

Last updated

Dec 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Optum Medical Group II Rhodes P C

  dba Southwest Medical

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1790329407
  Medicare reassignment NPD
• Yang Medical Services, PLLC

  dba Doctoroo

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1538729322
  Medicare reassignment NPD
• American Current Care PA

  dba Concentra Urgent Care

  • Urgent Care Clinic/Center
  • Addison, TX
  • NPI 1275714677

  NV

  Medicare reassignment NPD
• Southwest Medical Associates, Inc

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1659346005
  Medicare reassignment
• Optum Medical Group Rhodes P C

  dba Optumcare Anesthesia

  • Anesthesiology Physician
  • Las Vegas, NV
  • NPI 1770556037
  NPD
• American Current Care P.a.

  dba Concentra Urgent Care

  • Urgent Care Clinic/Center
  • Beaumont, TX
  • NPI 1376356568
  NPD
• NPI 1528602737

  • NPI 1528602737
  NPD (past)
• Pulmonary Specialist Group of Nevada

  dba The Lung Center of Nevada

  • Pulmonary Disease Physician
  • Las Vegas, NV
  • NPI 1720108442
  NPD (past)
• Qazi Makhija & Barney LLP

  • Nephrology Physician
  • Las Vegas, NV
  • NPI 1548330046
  NPD (past)
• Wolfson & Wolfson LLP

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1376635045
  NPD (past)

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1962934885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 RUBY VISTA CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891444101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 N NELLIS BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891105368",
            "telephone_number": "702-877-5199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9010 W Cheyenne Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891298932",
            "country_code": "US",
            "telephone_number": "702-240-8646",
            "fax_number": "702-932-8347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETLI",
        "first_name": "DOMINIC",
        "middle_name": "MASON",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-30",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "APRN002559",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "002559",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NV",
            "license": "APRN002559",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "74214",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "V59731",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Etheridge
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• Richard Etienne
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• Lilian Amaka Etoniru, LPN
• Okechukwu Prince Etoniru
• Alexis Eubanks
• Angelina Louise Eubanks

• Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.