SANTA ANN DOMINGUEZ (FNP) – Family Nurse Practitioner, NPI 1396391397
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
16,360 NURSE PRACTITIONER in CA
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Provider Addresses for SANTA ANN DOMINGUEZ (FNP)
PO BOX 1563
AVALON, CA 907041563
Phone: (310) 510-0096
Fax: (310) 510-2381
Type: Mailing
100, Falls Canyon Road, Avalon, Los Angeles County, California, 90704, United States
AVALON, CA 90704
Phone: (310) 510-0096
Fax: (310) 510-2381
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $21.
Total Amount is formed as General ($21) + Research ($0) + Ownership ($0) = $21.
Last reported payment date: 2023-11-15 • Largest payer in this snapshot: Organogenesis Inc. ($21).
Total Amount
$21
General + Research + Ownership
Payments
1
Total payment records
General Amount
$21
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Organogenesis Inc. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-03-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200317000343 | I | Nurse Practitioner | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 53 | 16 | $0 |
Insurance plans in this area (ZIP 90704)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology, Interventional Radiology | CA | |
| Clinical Social Worker | CA | |
| Marriage And Family Therapist | CA | |
| Family Practice, Sports Medicine | CA | |
| Family Practice | CA | |
| Nurse Practitioner | CA | |
| Internal Medicine | WI | |
| Clinical Social Worker | CA | |
| Nurse Practitioner | CA | |
| Clinical Social Worker | CA |
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