Dmitriy Shishkin

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN9288346 Issued in FL

Practice address

311 N Clyde Morris Blvd
Daytona Beach, FL 32114-2781

Phone

(386) 255-2340

NPI assigned

Dec 20, 2016

Last updated

Oct 24, 2022By the provider in NPPES

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Florida Clinical Practice Association IncGroup PAC ID 0345146254, 1,886 clinicians

Home DocsGroup PAC ID 9133432750, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Halifax Health Medical Center Hospital, Daytona Beach, FL, CCN 100017
• Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
• Adventhealth Deland Hospital, Deland, FL, CCN 100045

Merit-based Incentive Payment System (MIPS)

Final score

47.54 of 100Reported as apm

Quality

38.49

Promoting interoperability

0

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: dshishkin583569@direct.shands.ufl.edu
• FHIR API: https://api.platform.athenahealth.com/24896/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Florida Clinical Practice Association Inc

  dba UF Health Physicians

  • Surgery Physician
  • Gainesville, FL
  • NPI 1063463768
  Medicare reassignment Care Compare group NPD
• Home Docs

  • Family Nurse Practitioner
  • Orange City, FL
  • NPI 1518347038
  Medicare reassignment Care Compare group
• Kashyap Patel MD PA

  dba A-one family Practice

  • Family Medicine Physician
  • Ormond Beach, FL
  • NPI 1114037462
  Medicare reassignment NPD
• Primary Care of Oc LLC

  • Family Medicine Physician
  • Orange City, FL
  • NPI 1790541456
  Medicare reassignment NPD
• Primary Care of Orange City LLC

  • Family Medicine Physician
  • Orange City, FL
  • NPI 1831615087
  Medicare reassignment NPD
• Florida Clinical Practice Association Inc

  dba UF Health Family Medicine Ocala Heath Brook

  • Durable Medical Equipment & Medical Supplies
  • Ocala, FL
  • NPI 1609529478
  NPD
• Primary Care of Orange City LLC

  dba Home Wound Care Florida

  • Nurse Practitioner
  • Orange City, FL
  • NPI 1972249530
  NPD
• Volusia & Flagler OB-GYN PA

  • Specialist
  • Ormond Beach, FL
  • NPI 1932371598
  NPD (past)

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

• Halifax Hospital Medical Center

  dba Halifax Medical Center

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1811991227
  Care Compare affiliation
• Memorial Health Systems Inc

  dba AdventHealth Daytona Beach

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1063426823
  Care Compare affiliation
• Memorial Health Systems Inc

  dba AdventHealth Daytona Beach

  • Clinical Medical Laboratory
  • Daytona Beach, FL
  • NPI 1104696178

  Hospital

  Care Compare affiliation
• Memorial Hospital-West Volusia Inc

  dba AdventHealth DeLand

  • General Acute Care Hospital
  • Deland, FL
  • NPI 1649367269
  Care Compare affiliation

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1891230371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100265",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100265",
            "telephone_number": "352-273-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142781",
            "telephone_number": "386-255-2340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103620",
            "country_code": "US",
            "telephone_number": "352-273-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHISHKIN",
        "first_name": "DMITRIY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-20",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9288346",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "9288346",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Catehrine Shevlin, LCSW
• Deidre Ann Shimp, OCCUPATIONAL THERAPY
• Brian S Shin, MD
• Nikita Shinn
• Michael Shippole
• Jeevan Shivakumar, MD
• Kiran Shivaraj
• David Shoots, LCSW
• Shores Rehab Inc
• Hadassah Rose Shores

• Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.