DR. JOHN DOMINGUEZ PH.D.
NPI 1083311914
Psychologist - Clinical in Evanston, IL

Q: What is John Dominguez's NPI number?

The NPI number for John Dominguez is 1083311914. It was assigned to this individual provider in the NPPES registry on February 10, 2023.

Q: What is John Dominguez's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is John Dominguez enrolled in Medicare?

No. John Dominguez has opted out of Medicare through March 16, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for John Dominguez was last updated on February 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since February 10, 2023Opted out of Medicare · through Mar 16, 2027

500 DAVIS ST STE 815, EVANSTON, IL 60201(312) 640-7740 Get Directions Write a Review

NPPES record last updated: February 10, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. John Dominguez Ph.d. NPPES

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

DR. JOHN DOMINGUEZ PH.D. (NPI 1083311914) is an individual clinical provider in Evanston, Illinois, licensed in Illinois (071006465) and active in the NPI registry since February 2023. He has opted out of Medicare through March 16, 2027.

NPPES Registry Identity

NPI1083311914

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. JOHN DOMINGUEZCredential: PH.D.

Location Address500 DAVIS ST STE 815Evanston, IL 60201-4655

Mailing Address500 Davis St Ste 815Evanston, IL 60201-4655 · (312) 640-7740

Phone(312) 640-7740

Sole ProprietorNo

Enumeration DateFebruary 10, 2023

NPPES CertifiedFebruary 4, 2023

✔ NPI 1083311914 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in IL · 071006465

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

500 DAVIS ST STE 815, Evanston, IL 60201

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. John Dominguez Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 16, 2023 through March 16, 2027.

Opt-Out Effective DateMarch 16, 2023

Opt-Out In Effect ThroughMarch 16, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELLIOT PHILLIPS MA

Counselor (Mental Health)

500 DAVIS ST STE 815
EVANSTON, IL 60201

Cook County (312) 640-7740

DR. JANE FRESNE D.N.

Specialist

500 DAVIS ST STE 815
EVANSTON, IL 60201

Cook County (847) 425-9120

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 John Dominguez's NPI number?

The NPI number for John Dominguez is 1083311914. It was assigned to this individual provider in the NPPES registry on February 10, 2023.

Where is John Dominguez located?

John Dominguez practices at 500 Davis St Ste 815, Evanston, IL 60201. The listed phone number is (312) 640-7740.

What is John Dominguez's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is John Dominguez enrolled in Medicare?

No. John Dominguez has opted out of Medicare through March 16, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for John Dominguez was last updated on February 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.