DOMINIQUE ELY (AGACNP-BC) – Acute Care Nurse Practitioner, NPI 1629490081
Acute Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for DOMINIQUE ELY (AGACNP-BC)
PO BOX 19639
SPRINGFIELD, IL 627949639
Phone: (217) 545-8000
Type: Mailing
611 W PARK ST
BWPC
URBANA, IL 618012500
Phone: (217) 383-6941
Fax: (217) 383-4752
Type: Mailing
747 N Rutledge St Fl 4
Springfield, IL 627026700
Phone: (217) 545-8000
Type: Location
611 W Park St
Urbana, IL 618012500
Phone: (217) 383-3129
Fax: (217) 326-1550
Type: Location
302 W HAY ST STE 140
DECATUR, IL 625264168
Phone: (217) 872-2713
Fax: (217) 545-1958
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $57.
Total Amount is formed as General ($57) + Research ($0) + Ownership ($0) = $57.
Last reported payment date: 2024-04-09 • Largest payer in this snapshot: CARDIVA MEDICAL, INC. ($42).
Total Amount
$57
General + Research + Ownership
Payments
2
Total payment records
General Amount
$57
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-04-09
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CARDIVA MEDICAL, INC. | $42 |
| Janssen Pharmaceuticals, Inc | $15 |
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: 2014-02-20
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 |
|---|---|---|---|---|
| I20140220000660 | I | Nurse Practitioner | IL | 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 62794)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | IL | |
| Physician Assistant | IL | |
| Pulmonary Disease | IL | |
| D E R M A T O L O G Y | IL | |
| - | IL | |
| E N D O C R I N O L O G Y | IL | |
| Physician Assistant | IL | |
| General Surgery | IL | |
| Nurse Practitioner | IL | |
| Nurse Practitioner | IL |
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