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DOMINIQUE MICHELLE DONATELLI MD
NPI 1093399909
Anesthesiology in Grand Rapids, MI

Active since May 06, 2021PECOS EnrolledAccepts Medicare Assignment
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525(616) 364-7347 Get Directions Write a Review

NPPES record last updated: June 12, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 12, 2025, May 6, 2021 (2 updates tracked since 2021).

About Dominique Michelle Donatelli Md NPPES

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

DOMINIQUE MICHELLE DONATELLI MD (NPI 1093399909) is an individual anesthesiology provider in Grand Rapids, Michigan, licensed in Michigan (4351047691) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS, is affiliated with Spectrum Health, and maintains a secondary practice location in Royal Oak.

NPPES Registry Identity

NPI1093399909
Entity TypeIndividualFemale
Primary Taxonomy207L00000X
Provider Legal NameDOMINIQUE MICHELLE DONATELLICredential: MD
Location Address3333 EVERGREEN DR NEGrand Rapids, MI 49525-9493
Mailing Address2712 Miracle Ln NeGrand Rapids, MI 49525 · (630) 776-4594
Phone(616) 364-7347
Sole ProprietorNo
Medical School CMSUniversity Of Michigan Medical SchoolGraduated 2021
Enumeration DateMay 6, 2021
Last NPPES UpdateJune 12, 20252 updates tracked since enumeration
NPPES CertifiedMay 27, 2025
✔ NPI 1093399909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207L00000X
License✔ Licensed in MI · 4351047691
Definition
An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
3333 EVERGREEN DR NE, Grand Rapids, MI 49525
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Secondary Practice Location 1

Location 13601 W Thirteen Mile Rd, Beaumont Hospital GME OfficeRoyal Oak, MI 48073 · Phone (248) 898-5000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dominique Michelle Donatelli Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335548890
PECOS Enrollment IDI20250811001211
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 Reassignment

Medicare enrollment records show Dominique Donatelli reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Spectrum Health Primary Care Partners
1.6 mi
Nurse Practitioner
3271 CLEAR VISTA CT NE
Grand Rapids, MI 49525
  • Reassigned Medicare billing, Michigan enrollment
  • 2,446 clinicians in this Medicare group
NPI 1346480258 (616) 391-7800

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

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Spectrum Health

Acute Care Hospitals · Grand Rapids, MI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230038
Location100 Michigan St NEGrand Rapids, MI 49503 · Kent County
Emergency services Birthing friendly

University Of Michigan Health - West

Acute Care Hospitals · Wyoming, MI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230236
Location5900 Byron Center Avenue, SWWyoming, MI 49519 · Kent County
Emergency services Birthing friendly

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.

MR. JEFFREY RYAN HALL AA
Anesthesiologist Assistant
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
MRS. LINDSAY E MCKELVEY CRNA
Nurse Anesthetist, Certified Registered
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
DR. JEFFREY M RICKETTS DO
Anesthesiology
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
MRS. HEATHER M MONTGOMERY-KANITZ CRNA
Nurse Anesthetist, Certified Registered
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
DR. VIVIAN NNENNA ONYEWUCHE M.D.
Anesthesiology
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
DR. ERIC LEE LARSON MD
Anesthesiology
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
DR. ANNA MARIA UITVLUGT MD
Anesthesiology
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200
ANESTHESIA MEDICAL CONSULTANTS, PC
Anesthesiology
3333 EVERGREEN DR NE
GRAND RAPIDS, MI 49525
Kent County (616) 364-4200

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 Donatelli's NPI number?

The NPI number for Dominique Donatelli is 1093399909. It was assigned to this individual provider in the NPPES registry on May 6, 2021.

Where is Dominique Donatelli located?

Dominique Donatelli practices at 3333 Evergreen Dr NE, Grand Rapids, MI 49525. The listed phone number is (616) 364-7347.

What is Dominique Donatelli's specialty?

The primary specialty registered for this NPI is Anesthesiology with taxonomy code 207L00000X.

Is Dominique Donatelli enrolled in Medicare?

Yes. Dominique Donatelli is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Dominique Donatelli's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dominique Donatelli reassigns Medicare benefits to Spectrum Health Primary Care Partners (Grand Rapids, MI). The 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 Dominique Donatelli's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Dominique Donatelli affiliated with any hospitals?

According to CMS data, Dominique Donatelli is affiliated with Spectrum Health and University Of Michigan Health - West.

When was this NPI record last updated?

The NPPES record for Dominique Donatelli was last updated on June 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.