Pavel L Khimenko, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

18035 Issued in MS

Practice address

4211 Hospital St
Suite 107
Pascagoula, MS 39581-5310

Phone

(228) 202-3335

Fax

(228) 202-3337

NPI assigned

Nov 10, 2005

Last updated

Jan 18, 2012By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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.

• Coastal Cardiology, PC

  • Cardiovascular Disease Physician
  • Pascagoula, MS
  • NPI 1639239387
  Authorized official Same address or phone

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1548241904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST",
            "address_2": "SUITE 107",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815310",
            "telephone_number": "228-202-3335",
            "fax_number": "228-202-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST",
            "address_2": "SUITE 107",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815310",
            "telephone_number": "228-202-3335",
            "fax_number": "228-202-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHIMENKO",
        "first_name": "PAVEL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "18035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120919",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Eugene Justice, D.O.
• Anna Kahlmus, NP
• Jaswinder S Kandola, MD
• Carnetta Keeton
• Jessica Kendrick, RD, LD
• Kristen Coleman Kibby, LMSW
• Kidney Disease & Hypertension Centers, PA
• Kimoreas Love LLC
• Eliezer Chaim Kinberg, M.D.
• Martha June Kirby, PLPC

• Cardiovascular Disease Physician in Pascagoula, MS
• Providers in Pascagoula, MS by specialty
• Cardiovascular Disease Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.