DEREK GEORGE DOMBROSKI (MD) – Orthopaedic Trauma Physician, NPI 1992865869
Orthopaedic Trauma Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
779 ORTHOPEDIC SURGERY in WA
Provider Addresses for DEREK GEORGE DOMBROSKI (MD)
615 LILLY RD NE STE 100
OLYMPIA, WA 985065117
Phone: (360) 491-4211
Fax: (360) 493-0407
Type: Location
3382, Waialae Avenue, Kaimuki, Honolulu, Honolulu County, Hawaii, 96816, United States
HONOLULU, HI 968162637
Phone: (808) 548-7033
Type: Mailing
Ben Hogan Center, 800, 5th Avenue, Fort Worth, Tarrant County, Texas, 76104, United States
SUITE 500
FT WORTH, TX 76104
Phone: (817) 878-5300
Fax: (817) 878-5321
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 8 Open Payments records for all available years, with a total value of $622.
Total Amount is formed as General ($622) + Research ($0) + Ownership ($0) = $622.
Last reported payment date: 2024-11-07 • Largest payer in this snapshot: Smith+Nephew, Inc. ($396).
Total Amount
$622
General + Research + Ownership
Payments
8
Total payment records
General Amount
$622
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-07
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Smith+Nephew, Inc. | $396 |
| Stryker Corporation | $110 |
| Zimmer Biomet Holdings, Inc. | $49 |
| IlluminOss Medical, Inc. | $49 |
| PolyNovo North America LLC | $17 |
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: 2018-11-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20120510000423 | I | Orthopedic Surgery | TX | TBD |
| I20181114002449 | I | Orthopedic Surgery | HI | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 73 | 43 | $0 |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 40 | 39 | $0 |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 38 | 38 | $0 |
| 73552 | X-ray of thigh bone, minimum 2 views | 29 | 19 | $0 |
| 72170 | X-ray of pelvis, 1-2 views | 18 | 13 | $0 |
Insurance plans in this area (ZIP 98506)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ORTHOPEDIC SURGERY | TX | 73562 | X-ray of knee, 3 views | 31 | 18 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | TX | |
| Vascular Surgery | PA | |
| Internal Medicine | TX | |
| - | TX | |
| - | TX | |
| - | TX | |
| - | TX | |
| - | TX | |
| Cardiovascular Disease (Cardiology), Internal Medicine | TX | |
| Family Practice | TX |
Reviews
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