NPIMap

Organization Active NPI

Pokroy Medical Group of Nevada, LTD.

Doing business as Pediatrix Medical Group of Nevada, Ltd.

  • Neonatal-Perinatal Medicine Physician
  • Henderson, NV
National Provider Identifier
1235890062
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
Legal business name
POKROY MEDICAL GROUP OF NEVADA, LTD.
Doing business as
Pediatrix Medical Group of Nevada, Ltd.
Practice address
3001 Saint Rose Pkwy
Henderson, NV 89052-3839
Phone
(702) 616-5000
NPI assigned
Jan 4, 2022
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Kristina Deeter, MD
Title
Owner
Phone
(775) 982-6169

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU
Ophthalmology Physician 207W00000X NU
Pediatrics Physician 208000000X NU
Neonatal-Perinatal Medicine Physician 2080N0001X NU Primary
Pediatric Critical Care Medicine Physician 2080P0203X NU
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X NU

Addresses

Primary practice location

3001 Saint Rose Pkwy
Henderson, NV 89052-3839

Mailing address

File 50978
Los Angeles, CA 90074-0001

Other identifiers 1

IdentifierTypeStateIssuer
1992809412MedicaidNV

Other names 1

  • Pediatrix Medical Group of Nevada, Ltd. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pokroy Medical Group of Nevada LTD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1235890062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 50978",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 SAINT ROSE PKWY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523839",
            "telephone_number": "702-616-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POKROY MEDICAL GROUP OF NEVADA, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "DEETER",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-982-6169",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992809412",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrix Medical Group of Nevada, Ltd.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.