Individual provider Active NPI

Dina Kotova, FNP

  • Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1609219831
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP-02153 Issued in NM
Practice address
4320 The 25 Way NE Ste 400
Albuquerque, NM 87109-5881
Phone
(505) 808-3754
Fax
(505) 344-1060
NPI assigned
Apr 8, 2013
Last updated
Feb 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP-02153 NM Primary
Family Nurse Practitioner 363LF0000X CNP-02153 NM

Addresses

Primary practice location

4320 The 25 Way NE Ste 400
Albuquerque, NM 87109-5881

Mailing address

4320 The 25 Way NE Ste 400
Albuquerque, NM 87109-5881
Phone (505) 808-3754

Other identifiers 1

IdentifierTypeStateIssuer
93374534MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131008000364 NM Practitioner - Nurse Practitioner 8325272271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Link Medical IncGroup PAC ID 1759657604, 7 clinicians

Practice addresses (Care Compare)

110 Valencia Dr NE a
Albuquerque, NM 87108-1739
Phone (833) 224-5538

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Link Medical Inc CurrentSince Aug 29, 2023 Accepting new patients

Locations

6710 N 47th Ave
Ste 8
Glendale, AZ 85301
Phone (623) 842-3077

Interoperability endpoints

  • Direct secure messaging: dina.kotova@583211441192964.direct.elationemr.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1609219831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 THE 25 WAY NE STE 400",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095881",
            "telephone_number": "505-808-3754",
            "fax_number": "505-344-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 THE 25 WAY NE STE 400",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095881",
            "telephone_number": "505-808-3754",
            "fax_number": "505-344-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTOVA",
        "first_name": "DINA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-08",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-02153",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-02153",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93374534",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.