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KELLIE LYNN DOMINESSY PA-C, MMS, ATC
NPI 1932403383
Physician Assistant - Surgical in Fort Lauderdale, FL

Active since December 28, 2010PECOS Enrolled
2307 W BROWARD BLVD, STE 200, FORT LAUDERDALE, FL 33312(954) 792-1010(954) 792-1199 Get Directions Write a Review

NPPES record last updated: March 28, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kellie Lynn Dominessy Pa-c, Mms, Atc NPPES

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

KELLIE LYNN DOMINESSY PA-C, MMS, ATC (NPI 1932403383) is an individual surgical provider in Fort Lauderdale, Florida, licensed in Florida (PA9105661) and active in the NPI registry since December 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1932403383
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameKELLIE LYNN DOMINESSYCredential: PA-C, MMS, ATC
Location Address2307 W BROWARD BLVD, STE 200Fort Lauderdale, FL 33312-1417
Mailing Address2307 W Broward Blvd, Ste 200Fort Lauderdale, FL 33312-1417 · (954) 792-1010 · Fax (954) 792-1199
Phone(954) 792-1010
Fax(954) 792-1199
Sole ProprietorNo
Enumeration DateDecember 28, 2010
Last NPPES UpdateMarch 28, 2016
✔ NPI 1932403383 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in FL · PA9105661
Also ListedPhysician AssistantTaxonomy 363A00000X · License PA9105661 (FL)
2307 W BROWARD BLVD, Fort Lauderdale, FL 33312
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Other Identifiers 3

OtherY06HZFL · Bcbs
Medicaid003180000FL
Medicare PINEM387ZFL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Maintenance Organization of Florida.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kellie Lynn Dominessy Pa-c, Mms, Atc 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.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MIKEL CALDERON PA
Physician Assistant (Surgical)
2307 W BROWARD BLVD, STE 200
FORT LAUDERDALE, FL 33312
Broward County (954) 792-1010
TFPS IV, L.L.C.
Orthopaedic Surgery
2307 W BROWARD BLVD, STE 200
FT LAUDERDALE, FL 33312
Broward County (954) 792-1010
HOLLY L. GAINES MD
Internal Medicine (Cardiovascular Disease)
2307 W BROWARD BLVD
FORT LAUDERDALE, FL 33312
Broward County (954) 751-5400
WILLIAM VINCENT BURKE MD
Orthopaedic Surgery
2307 W BROWARD BLVD, STE 200
FORT LAUDERDALE, FL 33312
Broward County (954) 792-1010

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 Kellie Dominessy's NPI number?

The NPI number for Kellie Dominessy is 1932403383. It was assigned to this individual provider in the NPPES registry on December 28, 2010.

Where is Kellie Dominessy located?

Kellie Dominessy practices at 2307 W Broward Blvd Ste 200, Fort Lauderdale, FL 33312. The listed phone number is (954) 792-1010.

What is Kellie Dominessy's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Kellie Dominessy enrolled in Medicare?

Yes. Kellie Dominessy is registered in the Medicare PECOS enrollment system.

What insurance does Kellie Dominessy accept?

Health plans from Oscar Health Maintenance Organization of Florida list Kellie Dominessy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kellie Dominessy was last updated on March 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.