NPIMap

Individual provider Active NPI

Dmitriy Zhidovetskiy, DO

  • Internal Medicine Physician
  • Kansas City, KS
National Provider Identifier
1114205077
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
05-37288 Issued in KS
Practice address
3901 Rainbow Blvd. 6040 Delp, Ms 1020
Division of General and Geriatric Medicine, University
Kansas City, KS 66160-0001
Phone
(913) 588-6005
Fax
(913) 588-3877
NPI assigned
Jul 26, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5315051258 MI
Internal Medicine Physician 207R00000X 05-37288 KS Primary

Addresses

Primary practice location

3901 Rainbow Blvd. 6040 Delp, Ms 1020
Division of General and Geriatric Medicine, University
Kansas City, KS 66160-0001

Mailing address

3901 Rainbow Blvd. 4070 Delp, Ms 4017
Kansas University Physicians, Inc.
Kansas City, KS 66160-0001
Phone (913) 588-2501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20140902001417 KS Practitioner - HospitalistPractitioner - Internal Medicine 9234368689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kansas University Physicians IncGroup PAC ID 8921911587, 1,809 clinicians

Practice addresses (Care Compare)

3901 Rainbow Blvd
Kansas City, KS 66160-0001
Phone (913) 588-6431

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.91 of 100Reported as apm
Quality
77.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05-37288KSMDInternal Medicine Physician
5315051258MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kansas University Physicians Inc Internal Medicine CurrentSince Aug 12, 2014 Accepting new patients
Kansas University Physicians Inc CurrentSince Aug 12, 2014 Accepting new patients
Kansas University Physicians Inc Internal Medicine Current Accepting new patients
University of Kansas Hospital Authority Past Accepting new patients

Locations

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

11300 Corporate Ave
Ste 300
Lenexa, KS 66219

Interoperability endpoints

  • Direct secure messaging: dzhidovetskiy24797@direct.kuha.org

Organizations & group practices 4

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": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1114205077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD. 4070 DELP, MS 4017",
            "address_2": "KANSAS UNIVERSITY PHYSICIANS, INC.",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661600001",
            "telephone_number": "913-588-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 RAINBOW BLVD. 6040 DELP, MS 1020",
            "address_2": "DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661600001",
            "telephone_number": "913-588-6005",
            "fax_number": "913-588-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZHIDOVETSKIY",
        "first_name": "DMITRIY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5315051258",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "05-37288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, KS

Sources for this page

Verify at the official NPI Registry.