Individual provider Active NPI

Kevin Kapov, DO

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1932192614
Registry record updated May 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
959 Issued in NV
Practice address
4475 S Eastern Ave
Las Vegas, NV 89119
Phone
(702) 877-5199
NPI assigned
Aug 26, 2005
Last updated
May 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 959 NV Primary

Addresses

Primary practice location

4475 S Eastern Ave
Las Vegas, NV 89119

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 877-5199

Other practice location 1

270 W Lake Mead Pkwy
Henderson, NV 89015-7093
Phone (702) 677-3720

Other identifiers 2

IdentifierTypeStateIssuer
1932192614MedicaidNV
O00199240OtherNVRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20040824001154 NV Practitioner - Family Practice 6709850811 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
959NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Jul 15, 2013 Accepting new patients
Optum Medical Group Rhodes P C Current Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 9, 2019 Accepting new patients
Desert Valley Family Practice Family Medicine Past Accepting new patients
Linda L. Johnson MD, LTD Past Accepting new patients

Locations

270 W Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 677-3720

300 E Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 435-4301

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

4475 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 669-5811

Organizations & group practices 5

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1932192614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-877-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89119",
            "telephone_number": "702-877-5199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "270 W Lake Mead Pkwy",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890157093",
            "country_code": "US",
            "telephone_number": "702-677-3720",
            "fax_number": "702-677-3733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAPOV",
        "first_name": "KEVIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932192614",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "O00199240",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.