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Deactivated NPI 1760737654 Deactivated / Inactive NPI Male Practitioner

Mark Dedomenico

General Practice • Bellevue, WA

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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 Dedomenico has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 17, 2012
NPI Deactivation Date February 20, 2025
Total Practice Duration ~13 Years of Practice (2012 – 2025)

Professional Overview & Biography Verified Profile Summary

Mark Dedomenico was a registered General Practice practicing in Bellevue, WA. Throughout an active medical career spanning 13 years, Mark Dedomenico provided care at the practice location at 4455 148TH AVE NE until profile deactivation on 2025-02-20.

Practice Location & Contact Primary Location

Practice Address

4455 148th Ave Ne

Bellevue, WA 980073120

Telephone 4258675175
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Bellevue, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 44.0 Yrs
State Avg: 30.0 Yrs
Regional Practice Density
9 Specialists

Practicing in Bellevue, WA (423 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License WA MD00011381

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

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

40 Associated Practitioners
Dr. Travis Depew , PT, DPT

Physical Medicine & Rehabilitation

NPI 1023533874

Physical Therapist, Doctor of Physical Therapy

Micah Armbrust

Physical Therapist

NPI 1023663416
James Harris , PT

Physical Therapist

NPI 1033398672

Physical Therapist

Seema Patel , RD

Dietitian, Registered

NPI 1033701651

Registered Dietitian

Dr. Erianne Gustaf , DPT

Physical Therapist

NPI 1063768976

Doctor of Physical Therapy

Karina Tanguay , RD

Dietitian, Registered

NPI 1073639555

Registered Dietitian

Career & Practice History Timeline

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

8 Historical Events
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NPI Profile Deactivated February 20, 2025

Record deactivated on February 20, 2025

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 05, 2025

General Practice (License #MD00011381 in WA)

NPI Profile Active July 17, 2012

NPI status registered as active in NPPES database

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Updated Practice Location July 17, 2012

Registered at 4455 148TH AVE NE, BELLEVUE, WA 980073120 (Tel: 4258675175)

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Updated Business Mailing Address July 17, 2012

Registered at 4455 148TH AVE NE, BELLEVUE, WA 980073120

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Provider Name / Credentials Updated July 17, 2012

Recorded as MARK DEDOMENICO

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 17, 2012

General Practice (License #MD00011381 in WA)

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Initial NPI Registration & Enumeration July 17, 2012

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: 1760737654
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 17, 2012
Last Update: July 17, 2012
Deactivation Date: February 20, 2025

Mailing Address

4455 148th Ave Ne

Bellevue, WA 980073120

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.