Kim K Dernovsek, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

26084 Issued in CO

Practice address

1925 E Orman Ave
Ste 115
Pueblo, CO 81004-3537

Phone

(719) 564-4500

Fax

(719) 564-0304

NPI assigned

Feb 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Dermatology and Endocrinology LLC

  • Dermatology Physician
  • Pueblo, CO
  • NPI 1114999018
  Authorized official Same address or phone

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1497728786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 E ORMAN AVE",
            "address_2": "STE 115",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043537",
            "telephone_number": "719-564-4500",
            "fax_number": "719-564-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E ORMAN AVE",
            "address_2": "STE 115",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043537",
            "telephone_number": "719-564-4500",
            "fax_number": "719-564-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERNOVSEK",
        "first_name": "KIM",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-08",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "26084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070001062",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1497728786",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01260843",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denver Vamc
• Department of Veterans Affairs
• John Robert Dequardo, M.D.
• Dermatology and Endocrinology LLC
• Kenneth D Dernovsek, MD
• Derose Children's Dental Clinic, PC
• Michael Anthony Derose
• Katherine R Derossett, NP
• Lucas R Derting, PA-C
• Scott Alan Deruiter, M.D.

• Dermatology Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; 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.