Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Michael William Dominisse Jr., PA

Individual provider Physician Assistant · NPI 1962914580

Mr. Michael William Dominisse Jr., PA is a Physician Assistant in Fort Worth, Texas. Qualified in 2017, 9 years ago. Practices with Molly M Warthan MD, a 5-clinician group and accepts Medicare assignment.

Years since qualifying
9
In the registry since
2017
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

5751 Edwards Ranch Rd Ste 101
Fort Worth, TX 76109-4131
Phone: (817) 923-8220
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1962914580
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 5, 2017
Last updated in NPPESFebruary 23, 2026
Certification dateFebruary 23, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Molly M Warthan Md — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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