Individual provider Active NPI

Vadim Edward Korkhov, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Glen Burnie, MD
National Provider Identifier
1790725315
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
D0068240 Issued in MD
Practice address
301 Hospital Dr
Glen Burnie, MD 21061-5803
Phone
(410) 787-4000
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 231475 NY
Critical Care Medicine (Internal Medicine) Physician 207RC0200X D0068240 MD Primary

Addresses

Primary practice location

301 Hospital Dr
Glen Burnie, MD 21061-5803

Mailing address

1411 Grandview Ave
#103
Pittsburgh, PA 15211-1165
Phone (917) 476-2065

Other identifiers 2

IdentifierTypeStateIssuer
000000554504OtherINANTHEM
200890270MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20081111000650 MD Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 6507882933 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Paul Place Specialists, Inc.Group PAC ID 7719882943, 332 clinicians

Practice addresses (Care Compare)

301 Saint Paul St
Baltimore, MD 21202-2102

Hospital & facility affiliations

  • Mercy Medical Center Inc Hospital, Baltimore, MD, CCN 210008

Merit-based Incentive Payment System (MIPS)

Final score
79.13 of 100Reported as group
Quality
56.5
Promoting interoperability
100
Improvement activities
40
Cost
73.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0068240MDMDCritical Care Medicine (Internal Medicine) Physician
231475NYMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Paul Place Specialists, Inc. Critical Care Medicine CurrentSince Jun 5, 2014 Accepting new patients
St Paul Place Specialists Inc CurrentSince Jun 5, 2014 Accepting new patients
St. Paul Place Specialists, Inc. Current Accepting new patients
CHS Physician Partners, P.C Past Accepting new patients

Locations

345 Saint Paul St
Fl 9
Baltimore, MD 21202
Phone (410) 332-9610

Interoperability endpoints

  • Direct secure messaging: vkorkhov48594@direct.mdmercy.com

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 1

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223251200000",
    "number": "1790725315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 GRANDVIEW AVE",
            "address_2": "#103",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152111165",
            "telephone_number": "917-476-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615803",
            "telephone_number": "410-787-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORKHOV",
        "first_name": "VADIM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2008-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "231475",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "D0068240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000554504",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200890270",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.