Myra Dimitrov Dimitrov, M.D.
Individual provider Active NPI Family Medicine Physician · Palmer, AK
NPI 1134548464 · NPPES record last updated Nov 8, 2019
Key facts
- NPI
- 1134548464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 125163 (AK)
- Practice address
- 2323 S Trunk Rd Apt 6
Palmer, AK 99645 - Phone
- (907) 746-6644
- NPI assigned
- Apr 15, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 30
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Michigan State University College of Human Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bristol Bay Area Health Corporation
Practice addresses (Care Compare)
6000 Kanakanak Rd
Dillingham, AK 99576-0130
Phone (907) 842-5201
P O Box
Dillingham, AK 99576-0130
PO Box
Suite 130
Dillingham, AK 99576-0130
Phone (907) 842-5201
Hospital & facility affiliations
- Bristol Bay Dba Kanakanak Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210521001286 | TX | Practitioner - Family Practice | 2567724842 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
Locations
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
2323 S Trunk Rd
Apt 6
Palmer, AK 99645
Phone (907) 746-6644
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
711 Kapiolani Blvd
Honolulu, HI 96813
Phone (808) 432-5312
3288 Moanalua Rd
Honolulu, HI 96819
Phone (808) 265-9205
1010 Pensacola St
Honolulu, HI 96814
Phone (808) 432-2000
64-1035 Mamalahoa Hwy
Ste F
Kamuela, HI 96743
Phone (808) 885-5900
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/17479dfb-b021-49d0-9c8a-9247a410a2a3/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125163 | AK | Yes |
Addresses
Primary practice location
2323 S Trunk Rd Apt 6
Palmer, AK 99645
Mailing address
2323 S Trunk Rd Apt 6
Palmer, AK 99645-5940
Phone (907) 746-6644
Other practice location 1
104 W 5th Ave
Ste 200W
Spokane, WA 99204-4880
Phone (509) 624-2313
Other providers in Palmer, AK
- Alexandrea Dennison
- Guylene Derry
- Jacob Christopher Dewey
- Sara Jean Diamond
- Christopher David Dietrich
- Tatyana Disla
- Bailey Ditmer
- Polly Anderson Divens
- Division of Alaskan Pioneer Homes
- Elizabeth Ann Dixon
All providers in Palmer, AK · Family Medicine Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.