Ajdin Kobic, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

2024000630 Issued in MO

Practice address

1125 N Butterfield Rd
Bolivar, MO 65613-1056

Phone

(417) 328-4500

NPI assigned

Mar 27, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, MO, AZ3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Dermatology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citizens Memorial HealthcareGroup PAC ID 4183528169, 144 clinicians

Southwest Skin Specialists LLCGroup PAC ID 9739079864, 51 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Citizens Memorial Hospital Hospital, Bolivar, MO, CCN 260195

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: ajdin.kobic.p1@direct.dermga.nextgenshare.com

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.

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Southwest Skin Specialists LLC

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1174521926
  Medicare reassignment Care Compare group NPD
• Dermatology Associates of Georgia, LLC

  • Specialist
  • Decatur, GA
  • NPI 1063560803
  Medicare reassignment NPD
• Citizens Memorial Healthcare

  • Rural Health Clinic/Center
  • Willard, MO
  • NPI 1568127397
  NPD
• Southwest Skin Specialists, LLC

  • Clinical Medical Laboratory
  • Scottsdale, AZ
  • NPI 1609185347
  NPD

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

• Citizens Memorial Hospital District

  • General Acute Care Hospital
  • Bolivar, MO
  • NPI 1003981549
  Care Compare affiliation

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1104321587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N BUTTERFIELD RD",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131056",
            "telephone_number": "417-328-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N BUTTERFIELD RD",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131056",
            "telephone_number": "417-328-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1331 N 7th St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850062722",
            "country_code": "US",
            "telephone_number": "602-483-6504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOBIC",
        "first_name": "AJDIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "2024000630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Kelchen, M.D.
• Kemp Family Eye Care, LLC
• Lou Thelen Kemp, MA
• Wesley Don Kemp, O.D.
• Kayla Kittle, MD
• Zackery Koch, BA, MAADAC-I
• Kathleen Noell Kroutil, OTR/L
• Ashley Michele Lane, D.O.
• Lee A Lane, DPM, MPH
• Chad David Law, D.O.

• MOHS-Micrographic Surgery Physician in Bolivar, MO
• Providers in Bolivar, MO by specialty
• MOHS-Micrographic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.

Verify at the official NPI Registry.