DOMINIQUE ANN ERTOLACCI NP
NPI 1386291656
Nurse Practitioner in Springdale, AR

Q: What is Dominique Ertolacci's NPI number?

The NPI number for Dominique Ertolacci is 1386291656. It was assigned to this individual provider in the NPPES registry on August 21, 2019.

Q: What is Dominique Ertolacci's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since August 21, 2019PECOS Enrolled

609 W MAPLE AVE, SPRINGDALE, AR 72764(479) 553-1000 Get Directions Write a Review

NPPES record last updated: September 17, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 17, 2019, Aug 21, 2019 (2 updates tracked since 2019).

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About Dominique Ann Ertolacci Np NPPES

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

DOMINIQUE ANN ERTOLACCI NP (NPI 1386291656) is an individual nurse practitioner in Springdale, Arkansas, licensed in Arkansas (121999) and active in the NPI registry since August 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1386291656

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameDOMINIQUE ANN ERTOLACCICredential: NP

Location Address609 W MAPLE AVESpringdale, AR 72764-5335

Mailing Address609 W Maple AveSpringdale, AR 72764-5335 · (360) 560-8999 · Fax (479) 553-1000

Phone(479) 553-1000

Sole ProprietorNo

Enumeration DateAugust 21, 2019

Last NPPES UpdateSeptember 17, 20192 updates tracked since enumeration

✔ NPI 1386291656 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in AR · 121999

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

609 W MAPLE AVE, Springdale, AR 72764

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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 Ann Ertolacci Np 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72764 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

$79.72 typical visit price

range $51.36 – $157.74

Typical copayment $19.93 (range $12.84 – $39.43)

Most-billed visit code 99203

Established Patient

$91.63 typical visit price

range $16.16 – $128.77

Typical copayment $22.90 (range $4.04 – $32.19)

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.

ROBI EVERT AZUCENA TIAMZON

Registered Nurse (Emergency)