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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. SAMUEL DOMINGO MSN, FNP
NPI 1063254910
Nurse Practitioner - Family in Newport Beach, CA

Active since June 11, 2024PECOS Enrolled
1 HOAG DR, NEWPORT BEACH, CA 92663(949) 764-5691(949) 764-4242 Get Directions Write a Review

NPPES record last updated: September 7, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 7, 2026, Mar 13, 2026, Jun 11, 2024 (3 updates tracked since 2024).

About Mr. Samuel Domingo Msn, Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SAMUEL DOMINGO MSN, FNP (NPI 1063254910) is an individual family provider in Newport Beach, California, licensed in California (95029993) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063254910
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameMR. SAMUEL DOMINGOCredential: MSN, FNP
Location Address1 HOAG DRNewport Beach, CA 92663-4162
Mailing Address2119 PendioIrvine, CA 92620-1760 · (562) 540-6633
Phone(949) 764-5691
Fax(949) 764-4242
Sole ProprietorYes
Enumeration DateJune 11, 2024
Last NPPES UpdateSeptember 7, 20263 updates tracked since enumeration
NPPES CertifiedSeptember 7, 2026
✔ NPI 1063254910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95029993
1 HOAG DR, Newport Beach, CA 92663
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Samuel Domingo Msn, Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Samuel Domingo reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Hoag Clinic
0.3 mi
Primary Care
510 SUPERIOR AVE
Newport Beach, CA 92663
  • Reassigned Medicare billing, California enrollment
  • 529 clinicians in this Medicare group
NPI 1942799523 (949) 791-3001
Spine & Nerve Diagnostic Center
386 mi
Physical Medicine & Rehabilitation
2234 LONGPORT CT STE 100
Elk Grove, CA 95758
  • Reassigned Medicare billing, California enrollment
  • 25 clinicians in this Medicare group
NPI 1952770919 (916) 478-0112

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92663 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

DR. JACK MIN KAN M.D.
Anesthesiology
1 HOAG DR, DEPT OF ANESTHESIOLOGY
NEWPORT BEACH, CA 92663
Orange County (858) 565-9666
DR. MICHAEL GRAY MD
Hospitalist
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 610-7245
DR. ANDY YEN-TANG LEE MD
Internal Medicine (Advanced Heart Failure and Transplant Cardiology)
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 764-8135
KELLY GREENSTREET RD
Dietitian, Registered
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 764-8205
AMY KWAN MD
Hospitalist
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 873-6181
BRIAN KONG M.D.
Hospitalist
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 610-7245
CAPELLA TONG RD
Dietitian, Registered
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 764-8205
DANIEL KOERBER MD
Internal Medicine (Gastroenterology)
1 HOAG DR
NEWPORT BEACH, CA 92663
Orange County (949) 764-4624

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 Samuel Domingo's NPI number?

The NPI number for Samuel Domingo is 1063254910. It was assigned to this individual provider in the NPPES registry on June 11, 2024.

Where is Samuel Domingo located?

Samuel Domingo practices at 1 Hoag Dr, Newport Beach, CA 92663. The listed phone number is (949) 764-5691.

What is Samuel Domingo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Samuel Domingo enrolled in Medicare?

Yes. Samuel Domingo is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Samuel Domingo's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Domingo reassigns Medicare benefits to 2 organizations: Hoag Clinic (Newport Beach, CA) and Spine & Nerve Diagnostic Center (Elk Grove, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Domingo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Samuel Domingo was last updated on September 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days 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.