Deactivated NPI 1265509004 Deactivated / Inactive NPI Male Practitioner

Mark E Dome , PA

Physician Assistant • Baldwin Park, CA

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Mark Dome has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 29, 2006

NPI Deactivation Date June 19, 2025

Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Mark Dome, PA was a registered Physician Assistant practicing in Baldwin Park, CA. Throughout an active medical career spanning 19 years, Mark Dome provided care at the practice location at 1011 BALDWIN PARK BLVD until profile deactivation on 2025-06-19.

Historical Medicare Part B clinical services included removal of impacted ear wax, established patient outpatient office visit, diagnostic examination of nasal passages using an endoscope. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1011 Baldwin Park Blvd

Baldwin Park, CA 917065806

Telephone 6268511011

Associated Practice Facility / Clinic

🏢 Southern California Permanente Medical Group Facility NPI 1770515280

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Baldwin Park, CA

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 18.1 Yrs

State Avg: 11.5 Yrs

Regional Practice Density

32 Specialists

Practicing in Baldwin Park, CA (14617 Statewide)

Telehealth Adoption Rate

3.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

49.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	2,710	1,577	$80.07	$40.48
99213 Established patient office or other outpatient visit, typically 15 minutes	2,061	1,233	$151.76	$79.93
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	819	668	$213.88	$112.42
31231 Diagnostic examination of nasal passages using an endoscope	409	364	$320.05	$168.14
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	314	314	$185.57	$97.62
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	258	244	$94.77	$50.00
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	214	214	$277.75	$146.40
31575 Diagnostic exam of voice box using a flexible endoscope	167	152	$219.69	$79.65
92504 Exam of ear using a microscope	90	74	$49.47	$26.07
31238 Control of bleeding of nose using an endoscope	57	42	$432.16	$227.37
99202 New patient office or other outpatient visit, typically 20 minutes	43	43	$120.77	$63.73
69200 Removal of foreign body from ear canal	16	16	$136.18	$71.64

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	2,482	1,555	$80.42	$40.47
99213 Established patient office or other outpatient visit, typically 15 minutes	1,409	1,134	$151.70	$79.59
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	995	793	$95.56	$50.01
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	360	309	$214.25	$112.24
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	264	264	$188.19	$98.73
31231 Diagnostic examination of nasal passages using an endoscope	203	195	$328.30	$171.97
31575 Diagnostic exam of voice box using a flexible endoscope	163	152	$223.90	$106.88
99202 New patient office or other outpatient visit, typically 20 minutes	99	99	$122.04	$64.03
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	81	81	$278.56	$146.17
92504 Exam of ear using a microscope	59	44	$50.22	$26.28
31238 Control of bleeding of nose using an endoscope	38	34	$428.72	$224.39
69200 Removal of foreign body from ear canal	21	21	$144.20	$73.71
69220 Removal of skin debris and drainage of mastoid cavity	15	11	$133.86	$70.02

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	2,340	1,379	$60.02	$50.48
69210 Removal of impacted ear wax	2,226	1,391	$50.95	$41.10
99202 New patient office or other outpatient visit, typically 20 minutes	510	510	$77.55	$65.15
31231 Diagnostic examination of nasal passages using an endoscope	175	163	$208.89	$174.18
31575 Diagnostic exam of voice box using a flexible endoscope	158	147	$141.86	$102.11
99213 Established patient office or other outpatient visit, typically 15 minutes	110	101	$111.18	$80.25
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	74	74	$124.21	$100.02
G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing	64	64	$56.65	$46.40
31238 Control of bleeding of nose using an endoscope	54	50	$272.32	$227.29
92567 Eardrum testing using ear probe	21	20	$17.74	$14.96
69200 Removal of foreign body from ear canal	17	17	$86.29	$72.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	1,886	1,217	$50.38	$41.70
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	1,642	1,097	$59.29	$50.55
99213 Established patient office or other outpatient visit, typically 15 minutes	315	299	$92.14	$81.11
99202 New patient office or other outpatient visit, typically 20 minutes	204	204	$77.02	$65.69
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	203	203	$117.93	$100.71
31575 Diagnostic exam of voice box using a flexible endoscope	127	115	$137.67	$106.82
31231 Diagnostic examination of nasal passages using an endoscope	106	102	$214.60	$179.81
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	70	70	$176.77	$148.97
31238 Control of bleeding of nose using an endoscope	54	47	$267.98	$228.58
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	52	52	$24.23	$20.67
G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing	22	22	$54.03	$45.03
69200 Removal of foreign body from ear canal	14	14	$87.15	$71.66
92567 Eardrum testing using ear probe	13	13	$17.51	$14.92
30901 Simple control of nose bleed	11	11	$169.60	$144.66

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	1,881	1,227	$50.71	$41.71
99213 Established patient office or other outpatient visit, typically 15 minutes	1,563	1,055	$79.26	$67.86
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	480	402	$48.19	$41.09
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	384	383	$113.74	$97.25
31575 Diagnostic exam of voice box using a flexible endoscope	163	146	$132.02	$104.17
31231 Diagnostic examination of nasal passages using an endoscope	140	129	$210.04	$177.81
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	94	94	$172.80	$147.75
31238 Control of bleeding of nose using an endoscope	76	61	$269.35	$225.89
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	48	48	$114.72	$98.24
99202 New patient office or other outpatient visit, typically 20 minutes	17	17	$80.42	$68.46
69200 Removal of foreign body from ear canal	16	15	$86.97	$74.62

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	1,763	1,152	$49.88	$39.90
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	1,547	1,056	$48.00	$39.85
99213 Established patient office or other outpatient visit, typically 15 minutes	536	474	$78.16	$65.39
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	421	421	$113.59	$95.16
31575 Diagnostic exam of voice box using a flexible endoscope	277	240	$124.53	$94.27
99202 New patient office or other outpatient visit, typically 20 minutes	254	254	$80.42	$67.55
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	219	186	$24.77	$20.35
31231 Diagnostic examination of nasal passages using an endoscope	163	155	$216.73	$179.98
31238 Control of bleeding of nose using an endoscope	97	83	$268.37	$225.20
J1040 Injection, methylprednisolone acetate, 80 mg	38	29	$12.85	$12.02
J1100 Injection, dexamethasone sodium phosphate, 1 mg	38	29	$0.12	$0.12
30901 Simple control of nose bleed	37	35	$147.13	$123.37
G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing	28	28	$51.77	$43.55
69200 Removal of foreign body from ear canal	16	16	$92.39	$75.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
69210 Removal of impacted ear wax	495	416	$51.27	$42.45
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	294	244	$46.54	$40.83
99213 Established patient office or other outpatient visit, typically 15 minutes	283	244	$76.79	$67.62
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	202	202	$113.08	$99.49
31231 Diagnostic examination of nasal passages using an endoscope	174	162	$226.08	$199.08
31575 Diagnostic exam of voice box using a flexible endoscope	141	128	$120.09	$59.25
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	73	70	$23.10	$20.33
99202 New patient office or other outpatient visit, typically 20 minutes	72	72	$79.05	$69.50
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	61	61	$172.01	$151.38
G0268 Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing	46	46	$54.79	$47.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	28	27	$113.24	$99.71
31238 Control of bleeding of nose using an endoscope	25	23	$275.90	$242.94
30901 Simple control of nose bleed	15	13	$145.27	$127.92

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License CA PA13439

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

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Doctor of Medicine (M.D.)

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Doctor of Medicine (M.D.)

Dr. Yu-Chien Kuo , MD

Family Medicine

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Doctor of Medicine (M.D.)

Dr. Christine Chen-Hsu , MD

Physical Medicine & Rehabilitation

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Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

⚠️

NPI Profile Deactivated June 19, 2025

Record deactivated on June 19, 2025

✅

NPI Profile Active September 23, 2008

NPI status registered as active in NPPES database

📍

Updated Practice Location September 23, 2008

Registered at 1011 BALDWIN PARK BLVD, BALDWIN PARK, CA 917065806 (Tel: 6268511011)

📍

Updated Business Mailing Address September 23, 2008

Registered at 1011 BALDWIN PARK BLVD, BALDWIN PARK, CA 917065806 (Tel: 6268511011)

👤

Provider Name / Credentials Updated September 23, 2008

Recorded as MARK DOME, PA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 23, 2008

Physician Assistant (License #PA13439 in CA)

🟢

Initial NPI Registration & Enumeration November 29, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1265509004

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: November 29, 2006

Last Update: September 23, 2008

Deactivation Date: June 19, 2025

Update or Correct Profile

Mailing Address

1011 Baldwin Park Blvd

Baldwin Park, CA 917065806

Phone: 6268511011

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.