NPIMap

Individual provider Active NPI

David Stewart Koslov, MD

  • Urology Physician
  • San Bernardino, CA
National Provider Identifier
1043655525
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A168921 Issued in CA
Practice address
489 E 21St St
San Bernardino, CA 92404-4816
Phone
(909) 882-2973
Fax
(909) 882-2681
NPI assigned
May 9, 2013
Last updated
Sep 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X DR.0060248 CO
Urology Physician 208800000X A168921 CA Primary

Addresses

Primary practice location

489 E 21St St
San Bernardino, CA 92404-4816

Mailing address

489 E 21St St
San Bernardino, CA 92404-4816
Phone (909) 882-2973

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address davidkoslov@sburo.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200716002200 CA Practitioner - Urology 1153679428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Toledo College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franklin M Chu MD IncGroup PAC ID 7315978632, 7 clinicians

Practice addresses (Care Compare)

489 E 21St St
San Bernardino, CA 92404-4816
Phone (909) 882-2973

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A168921CAMDUrology Physician
DR.0060248COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franklin M Chu MD Inc CurrentSince Sep 1, 2020 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients
University of Colorado Hospital Authority Past Accepting new patients
Dignity Health Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients

Locations

489 E 21st St
Sn Bernrdno, CA 92404
Phone (909) 882-2973

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: davidkoslov@sburo.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1043655525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044816",
            "telephone_number": "909-882-2973",
            "fax_number": "909-882-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044816",
            "telephone_number": "909-882-2973",
            "fax_number": "909-882-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSLOV",
        "first_name": "DAVID",
        "middle_name": "STEWART",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-09",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "DR.0060248",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A168921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "davidkoslov@sburo.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "davidkoslov@sburo.allscriptsdirect.net",
            "address_1": "489 E 21st St",
            "city": "San Bernardino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "924044816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.