Tatyana R Demidovich, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

01059495A Issued in IN

Practice address

3635 Vista Ave FDT3
St Louis University
St Louis, MO 63110

Phone

(314) 577-8750

NPI assigned

Sep 22, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Anesthesiology

Education

University of Nebraska College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.94 of 100Reported as group

Quality

68.52

Promoting interoperability

100

Improvement activities

40

Cost

72.22

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tdemidovich26439@direct-ehr-ssmhc.com

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.

• SSM Health Care Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• SSM Health Care Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD (past)

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255996800000",
    "number": "1376539668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 VISTA FDT3",
            "address_2": "ST LOUIS UNIVERSITY",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE FDT3",
            "address_2": "ST LOUIS UNIVERSITY",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-577-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMIDOVICH",
        "first_name": "TATYANA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-22",
        "last_updated": "2009-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01059495A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200253830",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mildred Demeo, CRNA
• Lee Michael Demertzis, MD
• Angela Joann Demetrulias, OD
• Kamal R Demetry, M.D.
• Galina Demidenko, AGPCNP
• Rachel Stevens Deming, MD
• Melek Demirhan, MD
• Samantha Grace Demoor
• Meggan Caroline Dempewolf, DO
• Caitlin Dempsey

• Anesthesiology Physician in St Louis, MO
• Providers in St Louis, MO by specialty
• Anesthesiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.