Mrs Susan Dominguez, PSY24264 in Berkeley, CA - Medicare Psychologist Provider

Mrs Susan Dominguez, PSY24264 is a medicare enrolled "Psychologist - Intellectual & Developmental Disabilities" provider in Berkeley, California. Her current practice location is 3200 Adeline St, Berkeley, California. You can reach out to her office (for appointments etc.) via phone at (510) 601-0203.

Mrs Susan Dominguez is licensed to practice in California (license number PSY24264) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1477709483.

Contact Information

	Mrs Susan Dominguez, PSY24264
	3200 Adeline St, Berkeley, CA 94703-2407
	(510) 601-0203
	(510) 601-4002

Map and Direction

Healthcare Provider's Profile

Full Name	Mrs Susan Dominguez
Gender	Female
Speciality	Psychologist - Intellectual & Developmental Disabilities
Location	3200 Adeline St, Berkeley, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1477709483
Provider Enumeration Date: 08/09/2008
Last Update Date: 02/04/2026

Medicare PECOS Information:

PECOS PAC ID: 5890039689
Enrollment ID: I20181205001754

Medical Identifiers

Medical identifiers for Mrs Susan Dominguez such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1477709483	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TM1800X	Psychologist - Intellectual & Developmental Disabilities	PSY24264 (California)	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. Mrs Susan Dominguez allows following entities to bill medicare on her behalf.

Entity Name	County Of Santa Clara
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1588721500 PECOS PAC ID: 1254244973 Enrollment ID: O20040113000757

Entity Name	County Of Santa Clara
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1699885079 PECOS PAC ID: 1254244973 Enrollment ID: O20040113000784

Entity Name	County Of Santa Clara
Entity Type	Part B Supplier - Other Medical Care Group
Entity Identifiers	NPI Number: 1629301346 PECOS PAC ID: 1254244973 Enrollment ID: O20110318000170

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. Mrs Susan Dominguez 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
Mrs Susan Dominguez, PSY24264 6010 Highway 9 Ste 7, Felton, CA 95018-9535 Ph: (831) 515-6817	Mrs Susan Dominguez, PSY24264 3200 Adeline St, Berkeley, CA 94703-2407 Ph: (510) 601-0203

Reviews and Comments

Psychologist in Berkeley, CA

Ethan R Schwartz, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 2340 Ward St Ste 204, Berkeley, CA 94705 Phone: 510-658-5887
Dr. Noah Matthew Collins, PH.D. Psychologist Medicare: Accepting Medicare Assignments Practice Location: 768 Peralta Ave, Berkeley, CA 94707 Phone: 501-982-5337
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Himadhari Sharma, MA Psychologist Medicare: Not Enrolled in Medicare Practice Location: 2222 Bancroft Way Spc 4300, Berkeley, CA 94720 Phone: 510-642-9494 Fax: 510-642-2368
Dr. Lenora M Poe, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 2034 Blake St, #1, Berkeley, CA 94704 Phone: 510-845-7189 Fax: 510-845-2330
Dr. Michael Christopher Changaris, PSY.D. LIC#:PSY24712 Psychologist Medicare: Not Enrolled in Medicare Practice Location: 771 San Luis Rd, Berkeley, CA 94707 Phone: 510-214-2559
Dr. Matthew Reader Goodman, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 2222 Bancroft Way Spc 4300, Berkeley, CA 94720 Phone: 510-642-0695

Mrs Susan Dominguez, PSY24264 - Medicare Psychologist in Berkeley, CA