NPIMap

Individual provider Active NPI

Sergei V Chekov, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1265470306
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD418486 Issued in PA
Practice address
9892 Bustleton Ave
Suite 103
Philadelphia, PA 19115-2138
Phone
(215) 897-9090
Fax
(215) 897-9094
NPI assigned
Jun 2, 2006
Last updated
Jun 13, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD418486 PA Primary

Addresses

Primary practice location

9892 Bustleton Ave
Suite 103
Philadelphia, PA 19115-2138

Mailing address

9892 Bustleton Ave
Suite 103
Philadelphia, PA 19115-2138
Phone (215) 897-9090

Other identifiers 1

IdentifierTypeStateIssuer
101366436MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20050803000979 PA Practitioner - Internal Medicine 2365470911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9892 Bustleton Ave
Suite 103
Philadelphia, PA 19115-2138
Phone (215) 897-9090

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
39.6 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
83.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sergei Chekov MD PC Internal Medicine CurrentSince Oct 25, 2013 Accepting new patients

Locations

9892 Bustleton Ave
Ste 1
Philadelphia, PA 19115
Phone (215) 897-9090

9892 Bustleton Ave
Ste 103
Philadelphia, PA 19115
Phone (215) 897-9090

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EHCADD/Endpoint/EHCADD

Organizations & group practices 1

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.

Hospital & facility affiliations 8

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": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402617600000",
    "number": "1265470306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9892 BUSTLETON AVE",
            "address_2": "SUITE 103",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152138",
            "telephone_number": "215-897-9090",
            "fax_number": "215-897-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9892 BUSTLETON AVE",
            "address_2": "SUITE 103",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152138",
            "telephone_number": "215-897-9090",
            "fax_number": "215-897-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEKOV",
        "first_name": "SERGEI",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2014-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD418486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101366436",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.