Individual provider Active NPI

Dmitry K Pasikhov, MD

  • Surgery Physician
  • Lake Geneva, WI
National Provider Identifier
1780791012
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
44347 Issued in WI
Practice address
146 E Geneva Square
Lake Geneva, WI 53147
Phone
(262) 249-5000
Fax
(262) 249-7142
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 36100851 IL
Surgery Physician 208600000X 44347 WI Primary

Addresses

Primary practice location

146 E Geneva Square
Lake Geneva, WI 53147

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (414) 321-2255

Other identifiers 1

IdentifierTypeStateIssuer
34192400MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address dpasikhov41688@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20110223000916 WI Practitioner - General Surgery 2062693021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

146 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone (262) 249-5000

248 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-8000

252 McHenry St
Burlington, WI 53105-1828
Phone (262) 767-7000

W3985 County Rd NN
Elkhorn, WI 53121-4337
Phone (262) 741-2000

Hospital & facility affiliations

  • Aurora Lakeland Medical Center Hospital, Elkhorn, WI, CCN 520102
  • Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36100851ILMDSurgery Physician
44347WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jun 17, 2002 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 17, 2002 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

252 McHenry St
Burlington, WI 53105
Phone (262) 763-2411

248 McHenry St
Burlington, WI 53105
Phone (262) 767-8000

709 Spring Valley Rd
Burlington, WI 53105
Phone (262) 767-6020

201 E Morrissy Dr
Elkhorn, WI 53121
Phone (262) 723-3100

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

146 E Geneva Sq
Lake Geneva, WI 53147
Phone (262) 249-4678

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Interoperability endpoints

  • Direct secure messaging: dpasikhov41688@direct.myadvocateaurora.org

Organizations & group practices 3

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 2

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1780791012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "414-321-2255",
            "fax_number": "414-671-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 E GENEVA SQUARE",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "53147",
            "telephone_number": "262-249-5000",
            "fax_number": "262-249-7142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASIKHOV",
        "first_name": "DMITRY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "36100851",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "44347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34192400",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "146 E Geneva Square",
            "city": "Lake Geneva",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dpasikhov41688@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "146 E Geneva Square",
            "city": "Lake Geneva",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Geneva, WI

Sources for this page

Verify at the official NPI Registry.