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DR. DOMINIQUE M. JAN MD
NPI 1790726982
Surgery - Pediatric Surgery in Bronx, NY

Active since June 09, 2006PECOS Enrolled
100/100
CMS Quality Rating
3355 BAINBRIDGE AVE, BRONX, NY 10467(718) 920-7200(718) 547-2929 Get Directions Write a Review

NPPES record last updated: January 19, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Dominique M. Jan Md NPPES

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

DR. DOMINIQUE M. JAN MD (NPI 1790726982) is an individual pediatric surgery provider in Bronx, New York, licensed in New York (250182) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790726982
Entity TypeIndividualMale
Primary Taxonomy2086S0120X
Provider Legal NameDR. DOMINIQUE M. JANCredential: MD
Location Address3355 BAINBRIDGE AVEBronx, NY 10467-2801
Mailing Address3355 Bainbridge AveBronx, NY 10467-2801 · (718) 920-7200 · Fax (718) 547-2929
Phone(718) 920-7200
Fax(718) 547-2929
Sole ProprietorNo
Enumeration DateJune 9, 2006
Last NPPES UpdateJanuary 19, 2012
✔ NPI 1790726982 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0120X
License✔ Licensed in NY · 250182
Definition
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Also ListedTransplant SurgeryTaxonomy 204F00000X · License 0024381 (NY)
3355 BAINBRIDGE AVE, Bronx, NY 10467
Open in Google Maps ↗

Other Identifiers 3

Medicare UPINI48328NY
Medicaid02729091NY
Medicare ID-Type Unspecified517H21NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Dominique M. Jan Md 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 Dominique Jan reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Montefiore Medical Center
Same address
Anesthesiology
111 E 210TH ST
Bronx, NY 10467
  • Reassigned Medicare billing, New York enrollment
  • 5,251 clinicians in this Medicare group
NPI 1063525152 (914) 378-6021
Physician Affiliate Group Of New York PC
5.5 mi
Dietitian, Registered
506 LENOX AVE
New York, NY 10037
  • Reassigned Medicare billing, New York enrollment
  • 2,094 clinicians in this Medicare group
NPI 1013375526 (212) 939-2467

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

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.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Promoting Interoperability100
Improvement Activities40

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 Jan's NPI number?

The NPI number for Dominique Jan is 1790726982. It was assigned to this individual provider in the NPPES registry on June 9, 2006.

Where is Dominique Jan located?

Dominique Jan practices at 3355 Bainbridge Ave, Bronx, NY 10467. The listed phone number is (718) 920-7200.

What is Dominique Jan's specialty?

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

Is Dominique Jan enrolled in Medicare?

Yes. Dominique Jan is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Dominique Jan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dominique Jan reassigns Medicare benefits to 2 organizations: Montefiore Medical Center (Bronx, NY) and Physician Affiliate Group Of New York PC (New York, NY). 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 Dominique Jan'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 Dominique Jan was last updated on January 19, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.