JACOB DOMORACKI, CRNP — NPI 1245919448 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care in ERIE, PA)

CMS-1500 Box 24J / 33a • NPI

1245919448

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LA2100X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care

Box 32 Service Location & ZIP+4

232 W 25TH ST, ERIE, PA, 16544-0001

✓ 9-Digit EDI 837 ZIP+4 (16544-0001)

Practice Phone & Referral Fax

(814) 452-5000

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1245919448 (JACOB DOMORACKI, CRNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1245919448` (NPI-1 Individual Practitioner)
Provider / Legal Name	JACOB DOMORACKI, CRNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care NUCC Code: `363LA2100X` (Nurse Practitioner, Acute Care)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	232 W 25TH ST, ERIE, PA, 16544-0001
Practice Telephone / Fax	Tel: (814) 452-5000
Administrative Mailing Address	870 BROAD ST, CONNEAUT, OH, 44030-1710
Enumeration & Last Sync	Enumerated: 2023-07-14 \| CMS Record Updated: 2023-11-07

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

232 W 25TH ST, ERIE, PA, 16544-0001

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Plain-English Taxonomy & CMS Crosswalk (363LA2100X)

What Does Taxonomy Code 363LA2100X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2100X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Acute Care for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JACOB DOMORACKI, CRNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`163WC0200X` — Registered Nurse, Critical Care Medicine Plain English: Licensed & Credentialed Registered Nurse, Critical Care Medicine	State: PA \| License: `RN670780` \| Primary: Secondary
`363LA2100X` — Nurse Practitioner, Acute Care Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care	State: PA \| License: `SP028313` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JACOB DOMORACKI, CRNP (NPI #1245919448)