Santa Ann Dominguez, FNP is a medicare enrolled "Nurse Practitioner - Family" in Avalon, California. She graduated from nursing school in 2019 and has 5 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Avalon Medical Development Corporation and her current practice location is
100 Falls Canyon Road, Avalon, California. You can reach out to her office (for appointments etc.) via phone at
(310) 510-0096.
Santa Ann Dominguez is licensed to practice in California (license number 95012119) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1396391397.
Provider's Profile
| Full Name | Santa Ann Dominguez |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Practitioner |
|---|
| Experience | 5 Years |
|---|
| Location | 100 Falls Canyon Road, Avalon, California |
|---|
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
|---|
Medical Education and Training:
- Santa Ann Dominguez graduated from nursing school in 2019
NPI Data:
- NPI Number: 1396391397
- Provider Enumeration Date: 08/15/2019
- Last Update Date: 08/15/2019
Medicare PECOS Information:
- PECOS PAC ID: 9537597042
- Enrollment ID: I20200317000343
Medical Identifiers
Medical identifiers for Santa Ann Dominguez such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396391397 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | 95012119 (California) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Avalon Medical Development Corporation | 1850283995 | 8 |
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. Santa Ann Dominguez allows following entities to bill medicare on her behalf.
| Entity Name | Avalon Medical Development Corporation |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1346250347
PECOS PAC ID: 1850283995
Enrollment ID: O20040721000841 |
|---|
| Entity Name | Avalon Medical Development Corporation |
|---|
| Entity Type | Part A Provider - Critical Access Hospital |
|---|
| Entity Identifiers | NPI Number: 1346250347
PECOS PAC ID: 1850283995
Enrollment ID: O20061104000281 |
|---|
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. Santa Ann Dominguez 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 |
|---|
Santa Ann Dominguez, FNP
Po Box 1563,
Avalon, CA 90704-1563
Ph: (310) 510-0096 | Santa Ann Dominguez, FNP
100 Falls Canyon Road,
Avalon, CA 90704
Ph: (310) 510-0096 |
Reviews and Comments