Dr Jerome Taymon Domzalski, MD in Peoria, IL

Dr Jerome Taymon Domzalski, MD is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Peoria, Illinois. His current practice location is 530 Ne Glen Oak Ave, Peoria, Illinois. You can reach out to his office (for appointments etc.) via phone at (309) 655-2000.

Dr Jerome Taymon Domzalski is licensed to practice in Illinois (license number 036-164444) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1952539280.

Contact Information

	Dr Jerome Taymon Domzalski, MD
	530 Ne Glen Oak Ave, Peoria, IL 61637-4748
	(309) 655-2000
	Not Available

Map and Direction

Physician's Profile

Full Name	Dr Jerome Taymon Domzalski
Gender	Male
Speciality	Radiology - Diagnostic Radiology
Location	530 Ne Glen Oak Ave, Peoria, Illinois
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1952539280
Provider Enumeration Date: 06/25/2009
Last Update Date: 10/23/2023

Medicare PECOS Information:

PECOS PAC ID: 0840411047
Enrollment ID: I20180131002931

Medical Identifiers

Medical identifiers for Dr Jerome Taymon Domzalski such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1952539280	NPI	-	NPPES
0384868	Other	WA	LNI TRA-MINW, PS REST OF WA COUNTIES
0384886	Other	WA	LNI DINW
0408166	Other	WA	LNI RADIA REST OF WA
0384879	Other	WA	LNI TRA-MINW, PS KING COUNTY
0408173	Other	WA	LNI EVERGREEN RADIA
2094399	Medicaid	WA
0384883	Other	WA	LNI UAOM
0408171	Other	WA	LNI SWEDISH RADIA EDMONDS
0408174	Other	WA	LNI SOUTH SOUND RADIOLOGY
0408176	Other	WA	LNI SEATTLE RADIOLOGY
0408168	Other	WA	LNI RADIA KING COUNTY

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2085R0202X	Radiology - Diagnostic Radiology	MD185931 (Oregon)	Secondary
2085R0202X	Radiology - Diagnostic Radiology	MD60808674 (Washington)	Secondary
2085R0202X	Radiology - Diagnostic Radiology	M-14669 (Idaho)	Secondary
2085R0202X	Radiology - Diagnostic Radiology	036-164444 (Illinois)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jerome Taymon Domzalski allows following entities to bill medicare on his behalf.

Entity Name	Central Illinois Radiological Associates Ltd
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1538192828 PECOS PAC ID: 9436061827 Enrollment ID: O20161005002175

Entity Name	Cira Michigan Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1972141513 PECOS PAC ID: 7113355264 Enrollment ID: O20230526002009

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jerome Taymon Domzalski is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Jerome Taymon Domzalski, MD 111 Oakwood Rd, East Peoria, IL 61611-1853 Ph: (309) 740-4272	Dr Jerome Taymon Domzalski, MD 530 Ne Glen Oak Ave, Peoria, IL 61637-4748 Ph: (309) 655-2000

Reviews and Comments

Radiology Doctors in Peoria, IL

Dr. Lawrence C Wang, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 401 Sw Water St, 1824, Peoria, IL 61602 Phone: 309-494-9320
Dr. Matthew Trent Carpenter, MD Radiology Medicare: May Accept Medicare Assignments Practice Location: 221 Ne Glen Oak Ave, Department Of Radiation Oncology, Peoria, IL 61636 Phone: 309-672-5700 Fax: 309-671-2774
Dr. Cameron Wailynn Taylor, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000
Robert T Bockel, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 401 Sw Water St, Suite 507, Peoria, IL 61602 Phone: 309-494-9320
Dr. Steven J Ullenius, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000
Dr. Amanda Catherine Cross, M.D. Radiology Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61603 Phone: 309-655-2000
Dr. Derek Beatty, D.O. Radiology Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7768

Dr Jerome Taymon Domzalski, MD - Medicare Radiology in Peoria, IL