Individual provider Active NPI

Dmitri Khvolis, MD

  • Pediatrics Physician
  • Danville, PA
National Provider Identifier
1215515960
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD486041 Issued in PA
Practice address
100 N Academy Ave
Danville, PA 17822-3609
Phone
(570) 271-6144
NPI assigned
Apr 1, 2021
Last updated
Aug 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD486041 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

100 N Academy Ave
Danville, PA 17822-3609

Mailing address

506 6TH St
Brooklyn, NY 11215-3609
Phone (780) 718-3000

Other practice location 1

506 6th St
Brooklyn, NY 11215-3609
Phone (780) 718-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240827004671 PA Practitioner - Pediatric Medicine 4284173808 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD486041PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Aug 19, 2024 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Aug 19, 2024 Accepting new patients
Geisinger Medical Center Past Accepting new patients
Geisinger Clinic Pediatrics Past Accepting new patients
Geisinger Bloomsburg Hospital Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

400 Highland Ave
Lewistown, PA 17044
Phone (717) 242-7473

Interoperability endpoints

  • Direct secure messaging: dkhvolis594243@direct.geisinger.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1215515960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 6TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609",
            "telephone_number": "780-718-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178223609",
            "telephone_number": "570-271-6144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 6th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112153609",
            "country_code": "US",
            "telephone_number": "780-718-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHVOLIS",
        "first_name": "DMITRI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-01",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD486041",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, PA

Sources for this page

Verify at the official NPI Registry.