THOMAS JOSEPH IV DOMINGUEZ – Surgical Physician Assistant, NPI 1568945004
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for THOMAS JOSEPH IV DOMINGUEZ
2401 FRIST BLVD STE 5
FORT PIERCE, FL 349504800
Phone: (772) 465-8100
Fax: (772) 465-8689
Type: Mailing
1350 Hickory St
Melbourne, FL 329013224
Phone: (321) 434-3455
Type: Location
267 GRANT ST
BRIDGEPORT, CT 066102870
Phone: (203) 502-4723
Fax: (475) 246-9952
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $740.
Total Amount is formed as General ($740) + Research ($0) + Ownership ($0) = $740.
Last reported payment date: 2023-06-26 • Largest payer in this snapshot: ATRICURE, INC. ($740).
Total Amount
$740
General + Research + Ownership
Payments
5
Total payment records
General Amount
$740
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ATRICURE, INC. | $740 |
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: 2024-11-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20181029002582 | I | Physician Assistant | CT | TBD |
| I20200330000517 | I | Physician Assistant | FL | TBD |
| I20241111003657 | I | Physician Assistant | MD | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 34950)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | FL | |
| General Surgery | FL | |
| Internal Medicine | FL | |
| - | FL | |
| - | FL | |
| Physical Medicine And Rehabilitation | FL | |
| Family Practice | FL | |
| G A S T R O E N T E R O L O G Y | FL | |
| - | FL | |
| Nurse Practitioner | FL |
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