Dominique S Fertal, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Canandaigua, New York. She graduated from nursing school in 2017 and has 8 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice West Virginia University Medical Corporation and her current practice location is
350 Parrish St, Canandaigua, New York. You can reach out to her office (for appointments etc.) via phone at
(585) 919-2668.
Dominique S Fertal is licensed to practice in New York (license number 629842) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1891220810.
Provider's Profile
| Full Name | Dominique S Fertal |
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| Gender | Female |
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| Speciality | Certified Registered Nurse Anesthetist (crna) |
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| Experience | 8 Years |
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| Location | 350 Parrish St, Canandaigua, New York |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dominique S Fertal graduated from nursing school in 2017
NPI Data:
- NPI Number: 1891220810
- Provider Enumeration Date: 04/27/2017
- Last Update Date: 01/13/2020
Medicare PECOS Information:
- PECOS PAC ID: 6305114943
- Enrollment ID: I20230509001178
Medical Identifiers
Medical identifiers for Dominique S Fertal such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891220810 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | RN656120 (Pennsylvania) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | RN656120 (Pennsylvania) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 629842 (New York) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| West Virginia University Medical Corporation | 1052224565 | 1621 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dominique S Fertal allows following entities to bill medicare on her behalf.
| Entity Name | West Virginia University Medical Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275504508
PECOS PAC ID: 1052224565
Enrollment ID: O20031111000207 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dominique S Fertal is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dominique S Fertal, CRNA
601 Elmwood Ave Box 604,
Rochester, NY 14642-0001
Ph: (585) 275-1385 | Dominique S Fertal, CRNA
350 Parrish St,
Canandaigua, NY 14424-1731
Ph: (585) 919-2668 |
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