Dimitry A. Fomin, MD

Primary specialty

Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X

License

E5557 Issued in AR

Practice address

2708 Rife Medical LN
Suite 200
Rogers, AR 72758-1452

Phone

(479) 338-3720

Fax

(479) 338-3749

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

NeurologyAlso: Sleep Medicine

Education

Uniformed Services Uhs Fe Hebert School of Med, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Health Northwest Arkansas CommunitiesGroup PAC ID 0648177873, shared by 5 NPIs, 314 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010
• Mercy Hospital Berryville Hospital, Berryville, AR, CCN 041329

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dfomin22768@directc.mercy.net

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.

• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  Medicare reassignment NPD
• Mercy Health Northwest Arkansas Communities

  • Hospitalist Physician
  • Rogers, AR
  • NPI 1699076737
  Medicare reassignment NPD
• Mercy Hospital Berryville

  • Critical Access Hospital
  • Berryville, AR
  • NPI 1457306326
  Medicare reassignment NPD
• Mercy Health Northwest Arkansas Communities

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1407266760
  NPD
• Mercy Health Northwest Arkansas Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Rogers, AR
  • NPI 1770087371
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospital Berryville

  • Critical Access Hospital
  • Berryville, AR
  • NPI 1457306326
  Care Compare affiliation
• Mercy Hospital Rogers

  • General Acute Care Hospital
  • Rogers, AR
  • NPI 1316902414
  Care Compare affiliation

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1831171263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 RIFE MEDICAL LN",
            "address_2": "SUITE 200",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3720",
            "fax_number": "479-338-3749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 RIFE MEDICAL LN",
            "address_2": "SUITE 200",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581452",
            "telephone_number": "479-338-3720",
            "fax_number": "479-338-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMIN",
        "first_name": "DIMITRY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AR",
            "license": "E5557",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "AR",
            "license": "E5557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Lynn Flick, RD
• Lydia Flikkema
• Kera Colette Flippo, RPH
• Abril Flores
• Kayla Folven
• Britton Fontenot
• Jesse Wayne Ford, APRN
• Mary W. Ford, MS, CCC-SLP
• Peggy Ford
• Michael Forrest, ED.D.

• Sleep Medicine (Internal Medicine) Physician in Rogers, AR
• Providers in Rogers, AR by specialty
• Sleep Medicine (Internal Medicine) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.