Individual provider Active NPI

Ksenia Skorohodova, M.D.

  • Diagnostic Radiology Physician
  • Bedford, NH
National Provider Identifier
1720510175
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
315671 Issued in NY
Practice address
703 Riverway PL
Bedford, NH 03110-6745
Phone
(603) 627-1661
Fax
(603) 669-6944
NPI assigned
Apr 3, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 33106 NH
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 315671 NY Primary

Addresses

Primary practice location

703 Riverway PL
Bedford, NH 03110-6745

Mailing address

703 Riverway PL
Bedford, NH 03110-6745
Phone (603) 627-1661

Other names 1

  • Ksenia Skorokhodova Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NH2 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

Enrollment IDStateProvider typePAC IDDetails
I20220519001343 NY Practitioner - Diagnostic Radiology 6608144852 Reassigns benefits to 3 organizations
I20250522001473 NH Practitioner - Diagnostic Radiology 6608144852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Washington School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern New Hampshire Radiology Consultants PCGroup PAC ID 2769436088, 39 clinicians

Practice addresses (Care Compare)

225 E 36TH St
Apt 2N
New York, NY 10016-3664
Phone (603) 627-1661

703 Riverway PL
Bedford, NH 03110-6768
Phone (603) 627-1661

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33106NHMDDiagnostic Radiology Physician
315671NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern New Hampshire Radiology Consultants PC Diagnostic Radiology CurrentSince Sep 23, 2024 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the City of New York Diagnostic Radiology CurrentSince Apr 8, 2022 Accepting new patients
Columbiadoctors/Newyork-Presbyterianimaging CurrentSince Apr 8, 2022 Accepting new patients

Locations

703 Riverway Pl
Bedford, NH 03110
Phone (603) 668-7096

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

51 W 51st St
Ste 300
New York, NY 10019
Phone (212) 342-3666

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 4

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 7

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": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1720510175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PL",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106745",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PL",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106745",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOROHODOVA",
        "first_name": "KSENIA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-03",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NH",
            "license": "33106",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "315671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KSENIA",
            "last_name": "SKOROKHODOVA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bedford, NH

Sources for this page

Verify at the official NPI Registry.