NPIMap

Individual provider Active NPI

Daniel Sudilovsky, MD

  • Cytopathology Physician
  • Ithaca, NY
National Provider Identifier
1184619264
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cytopathology PhysicianTaxonomy code 207ZC0500X
License
237344 Issued in NY
Practice address
101 Dates Dr
Ithaca, NY 14850
Phone
(607) 274-4474
Fax
(607) 274-4481
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 237344 NY
Cytopathology Physician 207ZC0500X 237344 NY Primary

Addresses

Primary practice location

101 Dates Dr
Ithaca, NY 14850

Mailing address

PO Box 1849
Lewiston, ME 04241-1849
Phone (207) 784-2554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20210729000993 AZ Practitioner - Pathology 7911984109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kingman Healthcare IncGroup PAC ID 6901791367, 185 clinicians

Practice addresses (Care Compare)

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 757-2101

Hospital & facility affiliations

  • Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055
  • Havasu Regional Medical Center Hospital, Lake Havasu City, AZ, CCN 030069
  • Western Arizona Regional Medical Center Hospital, Bullhead City, AZ, CCN 030101
  • Valley View Medical Center Hospital, Fort Mohave, AZ, CCN 030117

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kingman Healthcare, Inc CurrentSince Aug 1, 2021 Accepting new patients
Kingman Healthcare, Inc CurrentSince Aug 1, 2021 Accepting new patients
Kingman Healthcare, Inc Current Accepting new patients
Marin Medical Laboratories Past Accepting new patients
Aesthetic Dermatology & Cosmetic Surgery Medical Associates, Inc Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients

Locations

1740 Sycamore Ave
Ste C
Kingman, AZ 86409
Phone (928) 263-3706

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

Interoperability endpoints

  • Direct secure messaging: daniel.sudilovsky@direct.azkrmc.md
  • Direct secure messaging: daniel.sudilovsky@st.direct.azkrmc.md

Organizations & group practices 6

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 5

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": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532304000000",
    "number": "1184619264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1849",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042411849",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DATES DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-274-4474",
            "fax_number": "607-274-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDILOVSKY",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2018-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "NY",
            "license": "237344",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NY",
            "license": "237344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.