CMS-1500 Box 24J / 33a • NPI
1720255201
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
225X00000X (CMS 67)
Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)
Box 32 Service Location & ZIP+4
49 LYME RD, HANOVER, NH, 03755-1205
✓ 9-Digit EDI 837 ZIP+4 (03755-1205)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1720255201 (JEREMY C DOMINA, OTR) 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
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1720255201)
Medicare Beneficiaries
31
Total Billed Services
630
Distinct CPT/HCPCS Codes
14
Medicare Allowed Total
$21,185.80
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 125 |
97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 95 |
97140 | Therapy procedure using manual technique, each 15 minutes | 77 |
97165 | Evaluation for occupational therapy, typically 30 minutes | 28 |
97530 | Therapy procedure using functional activities | 183 |
98975 | Set-up and patient education for remote monitoring of therapy | 20 |
98977 | Device supply with scheduled recording and transmission for remote monitoring of musculoskeletal system, per 30 days | 23 |
98980 | Remote therapeutic monitoring treatment management services by physician or other qualified health care professional, first 20 minutes per calendar month | 27 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1720255201 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | JEREMY C DOMINA, OTR |
| Plain-English Specialty | Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) NUCC Code: 225X00000X (Occupational Therapist) |
| Certifying / Licensing Body | National Board for Certification in Occupational Therapy (NBCOT) |
| Practice Location Address | 49 LYME RD, HANOVER, NH, 03755-1205 |
| Practice Telephone / Fax | Tel: (603) 643-2854 |
| Administrative Mailing Address | 227 OLD ROUTE 15, CAMBRIDGE, VT, 05444-9772 |
| Enumeration & Last Sync | Enumerated: 2008-05-13 | CMS Record Updated: 2008-05-13 |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (225X00000X)
What Does Taxonomy Code 225X00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225X00000X translates to:
"Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (JEREMY C DOMINA, OTR)
Typical CPT / Diagnostic Procedures:- Activities of Daily Living (ADL) & Neuromuscular Re-Education (CPT 97530–97535)
- Upper Extremity Hand Therapy, Custom Splinting & Home Safety Ergonomics
- Non-Pharmacological Functional & Sensory-Motor Rehabilitation Protocols
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
225X00000X — Occupational TherapistPlain English: Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) | State: NH | License: 1702 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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