JENNA MAE DOMINO APNP
NPI 1780174664
Nurse Practitioner - Family in Manitowoc, WI

Q: What is Jenna Domino's NPI number?

The NPI number for Jenna Domino is 1780174664. It was assigned to this individual provider in the NPPES registry on May 16, 2018.

Q: What is Jenna Domino's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jenna Domino was last updated on January 23, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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 May 16, 2018PECOS EnrolledAccepts Medicare Assignment

82.77/100

CMS Quality Rating

2300 WESTERN AVE, MANITOWOC, WI 54220(920) 320-3512 Get Directions Write a Review

NPPES record last updated: January 23, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 23, 2019, Jul 30, 2018, May 16, 2018 (3 updates tracked since 2018).

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About Jenna Mae Domino Apnp NPPES

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

JENNA MAE DOMINO APNP (NPI 1780174664) is an individual family provider in Manitowoc, Wisconsin, licensed in Wisconsin (8540-33) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS, is affiliated with Holy Family Memorial, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1780174664

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJENNA MAE DOMINOCredential: APNP

Location Address2300 WESTERN AVEManitowoc, WI 54220

Mailing Address937 S 39th StManitowoc, WI 54220-4707

Phone(920) 320-3512

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateMay 16, 2018

Last NPPES UpdateJanuary 23, 20193 updates tracked since enumeration

✔ NPI 1780174664 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in WI · 8540-33

Also ListedRegistered NurseTaxonomy 163W00000X · License 218918-30 (WI)

2300 WESTERN AVE, Manitowoc, WI 54220

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, HealthPartners, Network Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jenna Mae Domino Apnp 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 ID8628329133

PECOS Enrollment IDI20180922000031

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.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

111 services99 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

62 services58 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

30 services26 patients

Hospital Affiliations CMS Care Compare

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

Holy Family Memorial

Acute Care Hospitals · Manitowoc, WI

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number520107

Location2300 Western AveManitowoc, WI 54221 · Manitowoc County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54220 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

82.77/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

85.36

Promoting Interoperability

100

Improvement Activities

Cost

57.23

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.

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