NPIMap

Individual provider Active NPI

Kirill Sergeyevich Shishlov, M.D., MPH

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1114248077
Registry record updated Sep 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
138003 Issued in CA
Practice address
1000 10TH Ave
Emergency Department
New York, NY 10019-1147
Phone
(212) 523-3330
NPI assigned
Jun 15, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 138003 CA Primary

Addresses

Primary practice location

1000 10TH Ave
Emergency Department
New York, NY 10019-1147

Mailing address

1000 10TH Ave
Emergency Department
New York, NY 10019-1147
Phone (212) 523-3330

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
I20151005001407 CA Practitioner - Emergency Medicine 8729212386 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Duke University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, 2,047 clinicians
Regents of the University of CaliforniaGroup PAC ID 6406760131, 38 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025
  • El Centro Regional Medical Center Hospital, El Centro, CA, CCN 050045

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
138003CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Regents of the University of California CurrentSince Jul 1, 2016 Accepting new patients
Regents of the University of California Current Accepting new patients
Team Physicians of Northern California Medical Group Inc Emergency Medicine CurrentSince Aug 19, 2016 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California CurrentSince Nov 8, 2017 Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Nov 8, 2017 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

8910 Villa La Jolla Dr
Ste 100
La Jolla, CA 92037

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 9

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 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": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1114248077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHISHLOV",
        "first_name": "KIRILL",
        "middle_name": "SERGEYEVICH",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-15",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "138003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.