Active NPI
Dmitriy Markiv
- Durable Medical Equipment & Medical Supplies
- Sacramento, CA
National Provider Identifier
1295015089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 348977
- Practice address
- 3108 Arden Way
Sacramento, CA 95825-2002 - Phone
- (916) 485-2500
- Fax
- (916) 485-2500
- NPI assigned
- Aug 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 348977 | CA | Primary |
Addresses
Primary practice location
3108 Arden Way
Sacramento, CA 95825-2002
Mailing address
3108 Arden Way
Sacramento, CA 95825-2002
Phone (916) 485-2500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54748 | Other | CA | STATE OF CALIFORNIA HOME MEDICAL DEVICE RETAIL LICENSE |
| 348977 | Other | CA | COUNTY OF SACRAMENTO GENERAL BUSINESS LICENSE |
Other names 1
- Amd Medical Supply
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 348977 | CA | MD | Durable Medical Equipment & Medical Supplies |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amd Medical Supply, Inc. | Durable Medical Equipment & Medical Supplies | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Sacramento, CA
- NPI 1902103286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322524800000",
"number": "1295015089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3108 ARDEN WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958252002",
"telephone_number": "916-485-2500",
"fax_number": "916-485-2500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3108 ARDEN WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958252002",
"telephone_number": "916-485-2500",
"fax_number": "916-485-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKIV",
"first_name": "DMITRIY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-24",
"last_updated": "2011-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "348977",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF CALIFORNIA HOME MEDICAL DEVICE RETAIL LICENSE",
"identifier": "54748",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNTY OF SACRAMENTO GENERAL BUSINESS LICENSE",
"identifier": "348977",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "AMD",
"last_name": "MEDICAL SUPPLY",
"credential": "OWNER",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.