Simon Kotlyar

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

52012 Issued in CO

Practice address

1010 Three Springs Blvd
Durango, CO 81301-8296

Phone

(303) 306-7783

Fax

(303) 306-7753

NPI assigned

Jun 18, 2007

Last updated

Mar 31, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Simon Kotlyar Professional name

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Emergency Medicine, WA

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  dba Interstate Radiation Oncology

  • Radiation Oncology Clinic/Center
  • Portland, OR
  • NPI 1093043424
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1982959565

  Emergency Medicine

  NPD
• Lich Faculty Practice

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1104018902
  NPD (past)
• Long Island College Hospital

  dba Emergency physicians at LICH

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1912091828
  NPD (past)

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1629273941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17752",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170752",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 THREE SPRINGS BLVD",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813018296",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTLYAR",
        "first_name": "SIMON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-18",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "244490-1",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "044635",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "52012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82735085",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIMON",
            "last_name": "KOTLYAR",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sandra Koenig, CCC-SLP
• Kelsey Kolz, M.S., LPCC
• Jay Komarek, D.C., C.A.C.
• Kathleen Marie Korndoerfer, M.A.
• Julie Ann Kostuch, MA, LPC
• Kristin E Kozak, RN
• Gina MK Kramer, MCJ, LCSW
• Cynthia Renae Kraushaar, PT
• Kristin Spiegel, LCSW, LLC
• Jenna Marie Krizo, LAT

• Emergency Medicine Physician in Durango, CO
• Providers in Durango, CO by specialty
• Emergency Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; 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.