Individual provider Active NPI

Kimon Violaris

  • Pediatrics Physician
  • New York, NY
National Provider Identifier
1760458970
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
149709 Issued in NY
Practice address
Columbia University Department Pediatrics
3959 Broadway
New York, NY 10032
Phone
(212) 304-7250
Fax
(212) 544-1974
NPI assigned
Feb 27, 2006
Last updated
Dec 16, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 149709 NY Primary

Addresses

Primary practice location

Columbia University Department Pediatrics
3959 Broadway
New York, NY 10032

Mailing address

211 Heights Rd
Ridgewood, NJ 07450-2413
Phone (201) 612-6750

Other identifiers 1

IdentifierTypeStateIssuer
01195431MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180215000415 FL Practitioner - Pediatric Medicine 4082638770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

27400 Riverview Ctr Blvd
Suite 1
Bonita Springs, FL 34134-4324
Phone (877) 448-3627

341 Bullard Pkwy
Suite a B
Temple Terrace, FL 33617-5544
Phone (877) 448-3627

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Infectious Disease Consultants, LLC CurrentSince Jan 8, 2018 Accepting new patients
Metro Infectious Disease Consultants LLC CurrentSince Jan 8, 2018 Accepting new patients

Locations

27400 Riverview Center Blvd
Ste 1
Bonita Springs, FL 34134
Phone (239) 301-2319

6611 Orion Dr
Ste 103
Fort Myers, FL 33912

13550 SW 120th St
Ste 510
Miami, FL 33186

11000 Prosperity Farms Rd
Ste 102
Palm Beach Gardens, FL 33410
Phone (347) 820-2531

341 Bullard Pkwy
Ste Ab
Temple Terrace, FL 33617

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

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

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1760458970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 HEIGHTS RD",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502413",
            "telephone_number": "201-612-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS",
            "address_2": "3959 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "212-304-7250",
            "fax_number": "212-544-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIOLARIS",
        "first_name": "KIMON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "149709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01195431",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.