NPIMap

Individual provider Active NPI

Grigoriy Malyutin, M.D.

  • Vascular & Interventional Radiology Physician
  • Oklahoma City, OK
National Provider Identifier
1437680840
Registry record updated May 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
39526 Issued in OK
Practice address
1200 Everett Dr
Oklahoma City, OK 73104-5047
Phone
(405) 271-5125
NPI assigned
Mar 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X 39526 OK Primary

Addresses

Primary practice location

1200 Everett Dr
Oklahoma City, OK 73104-5047

Mailing address

1200 Everett Dr
Oklahoma City, OK 73104-5047
Phone (054) 271-5125

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
I20230609000157 PA Practitioner - Interventional Radiology 6305115130 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Radiology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penn State Health Medical Group LLCGroup PAC ID 8729351077, 720 clinicians
Quantum Imaging and Therapeutic Associates IncGroup PAC ID 1355254129, 92 clinicians

Practice addresses (Care Compare)

503 N 21St St
Camp Hill, PA 17011-2204
Phone (717) 234-2561

629 D Lowther Rd
Lewisberry, PA 17339-9527
Phone (717) 932-5200

Hospital & facility affiliations

  • Upmc Pinnacle Hospitals Hospital, Harrisburg, PA, CCN 390067
  • Penn State Health Holy Spirit Medical Center Hospital, Camp Hill, PA, CCN 390004
  • Upmc Memorial Hospital, York, PA, CCN 390101
  • Upmc Carlisle Hospital, Carlisle, PA, CCN 390058
  • Upmc Hanover Hospital, Hanover, PA, CCN 390233

Merit-based Incentive Payment System (MIPS)

Final score
81.93 of 100Reported as group
Quality
90.59
Improvement activities
40
Cost
57.01

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39526OKMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2023 Accepting new patients
Quantum Imaging & Therapeutic Associates Inc Vascular & Interventional Radiology CurrentSince Jul 1, 2023 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Aug 1, 2023 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients

Locations

503 N 21st St
Camp Hill, PA 17011
Phone (717) 763-2100

51 Business Campus Way
Ste 100
Duncannon, PA 17020
Phone (717) 834-3280

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

629D Lowther Rd
Lewisberry, PA 17339
Phone (717) 938-2765

Organizations & group practices 4

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653177600000",
    "number": "1437680840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 EVERETT DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045047",
            "telephone_number": "054-271-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 EVERETT DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045047",
            "telephone_number": "405-271-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALYUTIN",
        "first_name": "GRIGORIY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2022-05-22",
        "certification_date": "2022-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OK",
            "license": "39526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.