Active NPI
Dimitri Misailidis, MD
- Diagnostic Radiology Physician
- Martinsburg, WV
National Provider Identifier
1053356204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 15875
- Practice address
- 300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341 - Phone
- (304) 263-4967
- Fax
- (304) 267-5461
- NPI assigned
- Jun 19, 2006
- Last updated
- Feb 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 15875 | WV | Primary |
Addresses
Primary practice location
300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341
Mailing address
300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341
Phone (304) 263-4967
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 535851500 | Medicaid | MD | |
| 000848955 | Other | WV | WV BCBS |
| 0118129000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone (304) 264-1000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.34 of 100
- Quality
- 79.86
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15875 | WV | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Virginia University Medical Corporation | Current | Accepting new patients | |
| West Virginia University Medical Corporation | Diagnostic Radiology | Current | Accepting new patients |
Locations
2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134
1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500
300 S Preston St
Ranson, WV 25438
Phone (304) 728-1600
Organizations & group practices 3
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.
-
dba University Health Associates
- Family Medicine Physician
- Morgantown, WV
- NPI 1275504508
Diagnostic Radiology
-
- Diagnostic Radiology Physician
- Martinsburg, WV
- NPI 1922092568
-
dba Crisis Support and Recovery Center
- Community/Behavioral Health Agency
- Martinsburg, WV
- NPI 1174233530
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Berkeley Medical Center
- General Acute Care Hospital
- Martinsburg, WV
- NPI 1457389249
-
- Medicare Defined Swing Bed Hospital Unit
- Ranson, WV
- NPI 1104242569
-
dba Jefferson Medical Center
- Critical Access Hospital
- Ranson, WV
- NPI 1891722377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359676800000",
"number": "1053356204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 FOXCROFT AVE",
"address_2": "SUITE 202B",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254015341",
"telephone_number": "304-263-4967",
"fax_number": "304-267-5461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 FOXCROFT AVE",
"address_2": "SUITE 202B",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254015341",
"telephone_number": "304-263-4967",
"fax_number": "304-267-5461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISAILIDIS",
"first_name": "DIMITRI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-19",
"last_updated": "2013-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WV",
"license": "15875",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "535851500",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV BCBS",
"identifier": "000848955",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0118129000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.