DOMINIQUE PHUA
NPI 1053784413
Counselor - Addiction (Substance Use Disorder) in Grand Rapids, MI
About Dominique Phua NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DOMINIQUE PHUA (NPI 1053784413) is an individual addiction (substance use disorder) provider in Grand Rapids, Michigan, licensed in Michigan (3743369) and active in the NPI registry since November 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2014).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dominique Phua is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
GRAND RAPIDS, MI 49505
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dominique Phua's NPI number?
The NPI number for Dominique Phua is 1053784413. It was assigned to this individual provider in the NPPES registry on November 7, 2015.
Where is Dominique Phua located?
Dominique Phua practices at 1115 Ball Ave NE, Grand Rapids, MI 49505. The listed phone number is (616) 459-7215.
What is Dominique Phua's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.
Is Dominique Phua enrolled in Medicare?
Yes. Dominique Phua is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Dominique Phua was last updated on November 7, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dominique Phua · NPI 1053784413
Addiction (Substance Use Disorder) provider in Grand Rapids, Michigan. Individual provider, active in the CMS NPPES registry since November 7, 2015.
## Identity
- **NPI:** 1053784413 (Entity type: Individual)
- **Enumerated:** November 7, 2015
- **Primary specialty:** Counselor - Addiction (Substance Use Disorder) · taxonomy 101YA0400X
- **State license:** 3743369 (Michigan)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1115 BALL AVE NE, Grand Rapids, MI 49505-5904
- **Phone:** (616) 459-7215
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Medical school:** Other, class of 2014
## Record status
- **NPPES last updated:** November 7, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1053784413) · Data from the CMS NPPES public registry.