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DR. KATHLEEN MARIE DOMINGUEZ M.D.
NPI 1285764886
Surgery - Pediatric Surgery in Urbana, IL

Active since March 06, 2007PECOS Enrolled
611 W PARK ST, URBANA, IL 61801(217) 383-3100(217) 383-4468 Get Directions Write a Review

NPPES record last updated: October 21, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Kathleen Marie Dominguez M.d. NPPES

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

DR. KATHLEEN MARIE DOMINGUEZ M.D. (NPI 1285764886) is an individual pediatric surgery provider in Urbana, Illinois, licensed in Illinois (036146280) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1285764886
Entity TypeIndividualFemale
Primary Taxonomy2086S0120X
Provider Legal NameDR. KATHLEEN MARIE DOMINGUEZCredential: M.D.
Location Address611 W PARK STUrbana, IL 61801-2529
Mailing Address611 W Park StUrbana, IL 61801-2501
Phone(217) 383-3100
Fax(217) 383-4468
Sole ProprietorNo
Enumeration DateMarch 6, 2007
Last NPPES UpdateOctober 21, 2025
NPPES CertifiedOctober 21, 2025
✔ NPI 1285764886 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0120X
Licenses✔ Licensed in IL · 036146280✔ Licensed in WI · 57264
Definition
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Also ListedSurgeryTaxonomy 208600000X · License 036146280 (IL)
Also ListedSurgery · Surgical Critical CareTaxonomy 2086S0102X · License 036146280 (IL)
611 W PARK ST, Urbana, IL 61801
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Other Names 1

Former Name (1)Ms. Kathleen Marie Cavanagh

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kathleen Marie Dominguez M.d. 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 Kathleen Dominguez reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Carle Health Medical Group
Same address
Internal Medicine
611 W PARK ST
Urbana, IL 61801
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: Carle Health Care Incorporated
  • 2,516 clinicians in this Medicare group
NPI 1154653947 (217) 383-8300
Hoopeston Community Memorial Hospital
37 mi
Rural Health
801 E ORANGE ST
Hoopeston, IL 60942
  • Reassigned Medicare billing, Illinois enrollment
  • 488 clinicians in this Medicare group
NPI 1578504544 (214) 283-5644

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

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. UDAY BHASKAR KANAKADANDI MD
Internal Medicine (Interventional Cardiology)
611 W PARK ST, HVI
URBANA, IL 61801
Champaign County (217) 383-3110
DR. VIKAS DESAI MD
Urology
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3160
ANUJA BEDI D.O, M.P.H
Family Medicine
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
EMILY REMINGTON NP
Nurse Practitioner (Women's Health)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3140
MAHMOUD ELRAKHAWY MD
Surgery (Vascular Surgery)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 904-7000
KENDALL E WALLACE APRN
Nurse Practitioner (Family)
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
ANNE FAHNESTOCK PT
Physical Therapist
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 383-3311
TIMTIM APPERSON APRN
Family Medicine
611 W PARK ST
URBANA, IL 61801
Champaign County (217) 954-2805

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 Kathleen Dominguez's NPI number?

The NPI number for Kathleen Dominguez is 1285764886. It was assigned to this individual provider in the NPPES registry on March 6, 2007. The provider is also known as Ms. Kathleen Marie Cavanagh.

Where is Kathleen Dominguez located?

Kathleen Dominguez practices at 611 W Park St, Urbana, IL 61801. The listed phone number is (217) 383-3100.

What is Kathleen Dominguez's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.

Is Kathleen Dominguez enrolled in Medicare?

Yes. Kathleen Dominguez is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Kathleen Dominguez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathleen Dominguez reassigns Medicare benefits to 2 organizations: Carle Health Medical Group (Urbana, IL) and Hoopeston Community Memorial Hospital (Hoopeston, IL). 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 Kathleen Dominguez'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 Kathleen Dominguez was last updated on October 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.