NPIMap

Individual provider Active NPI

Alexander Wolodymyr Kmicikewycz, MD

  • Internal Medicine Physician
  • Palos Heights, IL
National Provider Identifier
1710097779
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036064794 Issued in IL
Practice address
12622 South Harlem Avenue
Palos Heights, IL 60463-1428
Phone
(708) 923-9610
Fax
(708) 923-9613
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036064794 IL Primary

Addresses

Primary practice location

12622 South Harlem Avenue
Palos Heights, IL 60463-1428

Mailing address

12622 South Harlem Avenue
Palos Heights, IL 60463-1428
Phone (708) 923-9610

Other identifiers 1

IdentifierTypeStateIssuer
31601176OtherBLUE CROSS BLUE SHIELD IL

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080306000440 IL Practitioner - Internal Medicine 2062597669 Practice locations: Palos Heights, IL

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12622 S Harlem Ave
Palos Heights, IL 60463-1428
Phone (708) 923-9610

Hospital & facility affiliations

  • Palos Community Hospital Home Health Care Home health agency, Lemont, IL, CCN 147470
  • Advocate Home Health Care Serv Home health agency, Oakbrook, IL, CCN 147150
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
  • Advocate Christ Hospital & Medical Center Hospital, Oak Lawn, IL, CCN 140208
  • Ingalls Memorial Hospital Hospital, Harvey, IL, CCN 140191
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Silver Cross Hospital and Medical Centers Hospital, New Lenox, IL, CCN 140213

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036064794ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alexander W. Kmicikewycz,MD Internal Medicine PastSince Jan 1, 1990 Accepting new patients
Major Hospital Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DJDBCA
  • Direct secure messaging: akmicikewycz276272@direct.myadvocateaurora.org

Organizations & group practices 2

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 11

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1710097779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12622 SOUTH HARLEM AVENUE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631428",
            "telephone_number": "708-923-9610",
            "fax_number": "708-923-9613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12622 SOUTH HARLEM AVENUE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631428",
            "telephone_number": "708-923-9610",
            "fax_number": "708-923-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KMICIKEWYCZ",
        "first_name": "ALEXANDER",
        "middle_name": "WOLODYMYR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036064794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "31601176",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "Advocate CMS",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Advocate CMS",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Advocate CMS",
            "address_1": "12622 South Harlem Avenue",
            "city": "Palos Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604631428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.