NPIMap

Individual provider Active NPI

Ivan Kamikovski, M.D.

  • Surgery Physician
  • Southfield, MI
National Provider Identifier
1073953030
Registry record updated Jul 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301103823 Issued in MI
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3073
NPI assigned
Jul 4, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301103823 MI Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

22655 Fairmont Dr
201
Farmington Hills, MI 48335-4067
Phone (917) 575-7418

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20220606001377 MN Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 9032597935 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

720 Washington Ave SE
Minneapolis, MN 55414-2924
Phone (612) 884-0649

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.67 of 100Reported as group
Quality
67.02
Promoting interoperability
99
Improvement activities
40
Cost
73.13

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301103823MIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Physicians CurrentSince Jul 15, 2022 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jul 15, 2022 Accepting new patients
Fairview Express Care CurrentSince Jul 15, 2022 Accepting new patients
Fairview Express Care CurrentSince Jul 15, 2022 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jul 15, 2022 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Pediatric Dental Clinic CurrentSince Jul 15, 2022 Accepting new patients
Fairview Health Services Past Accepting new patients
Cardiothoracic Surgery Clinic of North Ms Past Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

1900 Centracare Cir
#500
Saint Cloud, MN 56303
Phone (320) 229-5099

1900 Centracare Cir
Ste 500
Saint Cloud, MN 56303
Phone (320) 229-5099

Interoperability endpoints

  • Direct secure messaging: ikamikovski634242@direct.centracare.com

Organizations & group practices 11

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

Hospital & facility affiliations 7

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": "1372896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372896000000",
    "number": "1073953030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22655 FAIRMONT DR",
            "address_2": "201",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483354067",
            "telephone_number": "917-575-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMIKOVSKI",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-04",
        "last_updated": "2013-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301103823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.