Active NPI 1962914580 Individual Practitioner Male Practitioner

Michael William Dominisse , PA

Physician Assistant • Fort Worth, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Michael Dominisse, PA is a certified Physician Assistant practicing in Fort Worth, TX. With approximately 9 years of clinical experience since completing medical education in 2017, Michael Dominisse delivers high-quality medical care to the local community at 5751 EDWARDS RANCH RD STE 101.

Michael Dominisse is affiliated with Molly M Warthan Md and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

5751 Edwards Ranch Rd Ste 101

Fort Worth, TX 761094131

Telephone 8179238220

Associated Practice Facility / Clinic

🏢 Molly M Warthan Md Facility NPI 1306228432

Medicare Profile & Education

Medical School

Other

Graduation Year

2017

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Fort Worth, TX

Experienced Practitioner (5-10 Yrs)

Practitioner Clinical Experience

9 Yrs -1.1 yrs vs City Avg

City Avg: 10.1 Yrs

State Avg: 13.9 Yrs

Regional Practice Density

604 Specialists

Practicing in Fort Worth, TX (11140 Statewide)

Telehealth Adoption Rate

13.2% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

70.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Dominisse (9 Years) 9 Yrs

Fort Worth Specialty Average (10.1 Years) 10.1 Yrs

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
17003 Destruction of precancer skin growth, 2-14 growths	62	15	$31.94	$5.44
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	47	43	$281.64	$105.99
17000 Destruction of skin growth	15	15	$190.00	$33.29
17110 Destruction of up to 14 skin growths	11	11	$273.27	$85.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,561	274	$24.97	$6.26
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	476	370	$189.78	$113.74
17000 Destruction of skin growth	414	310	$125.31	$41.04
11102 Tangential biopsy of single skin lesion	321	253	$166.39	$78.38
17110 Destruction of up to 14 skin growths	253	199	$183.23	$104.39
99213 Established patient office or other outpatient visit, typically 15 minutes	236	169	$140.06	$80.58
11103 Biopsy of related skin growth, each additional growth	205	106	$85.00	$46.43
17004 Destruction of precancer skin growth, 15 or more growths	66	50	$269.23	$154.64
99202 New patient office or other outpatient visit, typically 20 minutes	26	26	$122.50	$65.05
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	22	19	$290.00	$156.23
96573 Application of light by qualified health care professional to destroy precancer skin growth	19	19	$350.00	$217.40
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	19	19	$517.11	$385.06
11104 Punch biopsy, first skin growth	14	13	$205.00	$116.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	14	$86.07	$50.72
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	13	13	$491.92	$279.22
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$171.54	$99.37
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	12	11	$370.00	$104.44
10060 Simple or single drainage of skin abscess	11	11	$239.09	$114.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,174	352	$24.97	$6.25
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	602	414	$170.00	$114.02
17000 Destruction of skin growth	582	388	$125.64	$40.94
11102 Tangential biopsy of single skin lesion	440	312	$160.00	$76.50
17110 Destruction of up to 14 skin growths	309	250	$180.00	$103.14
11103 Biopsy of related skin growth, each additional growth	268	136	$85.28	$46.86
99213 Established patient office or other outpatient visit, typically 15 minutes	249	204	$115.00	$80.76
17004 Destruction of precancer skin growth, 15 or more growths	113	88	$250.00	$154.33
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	50	42	$290.00	$156.01
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	41	31	$370.00	$111.59
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	38	$70.00	$50.40
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	39	39	$170.00	$99.48
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	36	32	$485.00	$276.98
99202 New patient office or other outpatient visit, typically 20 minutes	29	29	$120.00	$64.87
10060 Simple or single drainage of skin abscess	11	11	$190.00	$112.83

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,465	333	$25.00	$5.99
17000 Destruction of skin growth	535	365	$125.00	$39.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	533	374	$170.00	$115.52
11102 Tangential biopsy of single skin lesion	392	289	$160.00	$80.26
17110 Destruction of up to 14 skin growths	308	254	$180.00	$102.97
11103 Biopsy of related skin growth, each additional growth	291	142	$85.00	$48.39
99213 Established patient office or other outpatient visit, typically 15 minutes	287	213	$115.00	$80.65
17004 Destruction of precancer skin growth, 15 or more growths	127	96	$250.00	$151.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	56	49	$70.00	$50.22
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	38	28	$290.00	$143.96
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	29	29	$170.00	$91.51
99202 New patient office or other outpatient visit, typically 20 minutes	28	28	$120.00	$64.82
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	28	22	$240.00	$106.70
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	23	21	$485.00	$283.01
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	17	16	$370.00	$105.86
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	11	11	$475.00	$390.47
96573 Application of light by qualified health care professional to destroy precancer skin growth	11	11	$350.00	$219.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,997	267	$25.00	$5.51
17000 Destruction of skin growth	437	302	$125.00	$39.79
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	423	308	$170.00	$96.39
11102 Tangential biopsy of single skin lesion	328	248	$160.00	$74.36
17110 Destruction of up to 14 skin growths	247	194	$180.00	$101.54
11103 Biopsy of related skin growth, each additional growth	202	108	$85.00	$48.05
99213 Established patient office or other outpatient visit, typically 15 minutes	168	138	$115.00	$66.87
17004 Destruction of precancer skin growth, 15 or more growths	72	60	$250.00	$140.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	64	64	$170.00	$95.85
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	62	55	$70.00	$40.37
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	33	24	$287.27	$143.49
99202 New patient office or other outpatient visit, typically 20 minutes	24	24	$120.00	$66.19
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	11	11	$482.27	$274.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	721	134	$25.00	$4.99
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	184	175	$170.00	$95.78
17000 Destruction of skin growth	171	155	$125.00	$37.97
11102 Tangential biopsy of single skin lesion	128	118	$160.00	$74.07
17110 Destruction of up to 14 skin growths	112	98	$180.00	$99.51
99213 Established patient office or other outpatient visit, typically 15 minutes	70	62	$115.00	$65.77
11103 Biopsy of related skin growth, each additional growth	53	40	$85.00	$48.16
17004 Destruction of precancer skin growth, 15 or more growths	40	37	$250.00	$136.21
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	28	28	$170.00	$95.44
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	23	$70.00	$40.23

Medical Specialties & State Licenses

CMS Verified: 2026-02-23

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

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.

Hospital & Practice Group Affiliations

Molly M Warthan Md

5751 Edwards Ranch Rd, Fort Worth, TX 761094131

Phone: 8179238220

Practice Associates & Co-Workers

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

3 Associated Practitioners

Dr. Molly Warthan , MD

Dermatology

NPI 1073773867

Doctor of Medicine (M.D.)

Anna Buck , PA-C

Physician Assistant

NPI 1174278667

Physician Assistant (Certified)

Dr. Matthew Mittelbronn , MD

Dermatology

NPI 1801838537

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

8 Historical Events

📍

Updated Practice Location February 23, 2026

Registered at 5751 EDWARDS RANCH RD STE 101, FORT WORTH, TX 761094131 (Tel: 8179238220)

📍

Updated Business Mailing Address February 23, 2026

Registered at 210 CANYON CREEK CIR, CANYON CREEK CIRCLE, WEATHERFORD, TX 760874039 (Tel: 9164027388)

✅

NPI Profile Active November 05, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location November 05, 2017

Registered at 111 ALVASTON CT, FOLSOM, CA 956308614 (Tel: 9164027388)

📍

Updated Business Mailing Address November 05, 2017

Registered at 111 ALVASTON CT, FOLSOM, CA 956308614 (Tel: 9164027388)

👤

Provider Name / Credentials Updated November 05, 2017

Recorded as MICHAEL DOMINISSE, PA

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 05, 2017

Physician Assistant

🟢

Initial NPI Registration & Enumeration November 05, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1962914580

Entity Type:

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

Enumeration Date: November 05, 2017

Last Update: February 23, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

210 Canyon Creek Cir, Canyon Creek Circle

Weatherford, TX 760874039

Phone: 9164027388

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.