Piotr T Dyk, M.D.
Individual provider Active NPI Nephrology Physician · Lake Saint Louis, MO
NPI 1194712927 · NPPES record last updated Sep 19, 2024
Key facts
- NPI
- 1194712927
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 36787 (MO)
- Practice address
- 1000 Edgewater PT Ste 303
Lake Saint Louis, MO 63367-2954 - Phone
- (636) 265-2225
- NPI assigned
- Oct 6, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1000 Edgewater PT
Suite 303
Lake St Louis, MO 63367-2954
Phone (636) 265-2225
Hospital & facility affiliations
- DaVita Lake St Louis Dialysis
- DaVita St. Peters Dialysis
- DaVita Lake St. Louis Home At Home
- SSM St Joseph Hospital West
- SSM St Joseph Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20090415000200 | MO | Practitioner - Nephrology | 7113074865 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36787 | MO | MD | Nephrology Physician |
Interoperability endpoints
- pdyk21191@direct-ehr-ssmhc.com
- piotr.dyk@direct.davitaphysiciansolutions.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 36787 | MO | Yes |
Addresses
Primary practice location
1000 Edgewater PT Ste 303
Lake Saint Louis, MO 63367-2954
Mailing address
1000 Edgewater PT Ste 303
Lake St Louis, MO 63367-2954
Phone (636) 265-2225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203554118 | Medicaid | MO |
Other providers in Lake Saint Louis, MO
- Andrew Dawson
- Michelle R Difranco
- Mary Catherine Downen
- Haley Anne Downs
- Andrew Drysdale
- Echoes of Hope
- Emily Christine Elmendorf
- Endoscopy Center of St. Louis
- Erik Evans
- Ashley Fagan
All providers in Lake Saint Louis, MO · Nephrology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2024. 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.