Active NPI
Dmitri Pavlo Dmytruk, D.O.
- Physical Medicine & Rehabilitation Physician
- Portsmouth, NH
National Provider Identifier
1952577751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 14493
- Practice address
- 875 Greenland Rd Unit C4
Portsmouth, NH 03801-4163 - Phone
- (603) 431-5529
- Fax
- (603) 436-6603
- NPI assigned
- May 1, 2008
- Last updated
- Apr 17, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 229604 | MA | |
| Physical Medicine & Rehabilitation Physician | 208100000X | 14493 | NH | Primary |
Addresses
Primary practice location
875 Greenland Rd Unit C4
Portsmouth, NH 03801-4163
Mailing address
105 Corporate Drive
Portsmouth, NH 03801
Phone (603) 501-5584
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3084211 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Medicine and Rehabilitation
- Education
- New York College of Osteo Medicine of New York Institute of Technology, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
105 Corporate Dr
Portsmouth, NH 03801-6825
Phone (603) 501-5584
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 229604 | MA | MD | Physical Medicine & Rehabilitation Physician |
| 14493 | NH | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NRHN Rehab Physician Services, Inc | Physical Medicine & Rehabilitation | Current | Accepting new patients |
Locations
105 Corporate Dr
Portsmouth, NH 03801
Phone (603) 501-5500
Interoperability endpoints
- dmitri.dmytruk.1@6076.direct.athenahealth.com
- https://api.platform.athenahealth.com/6076/brand/1/csg/1/fhir/r4
Organizations & group practices 1
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.
-
- Physical Medicine & Rehabilitation Physician
- Portsmouth, NH
- NPI 1831436633
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Portsmouth Regional Hospital
- General Acute Care Hospital
- Portsmouth, NH
- NPI 1518913607
-
dba Northeast Rehabilitation Health Network
- Rehabilitation Hospital
- Salem, NH
- NPI 1255354288
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Dover, NH
- NPI 1033118104
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587081600000",
"number": "1952577751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 CORPORATE DRIVE",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "03801",
"telephone_number": "603-501-5584",
"fax_number": "603-501-5650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 GREENLAND RD UNIT C4",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038014163",
"telephone_number": "603-431-5529",
"fax_number": "603-436-6603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DMYTRUK",
"first_name": "DMITRI",
"middle_name": "PAVLO",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-01",
"last_updated": "2020-04-17",
"certification_date": "2020-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MA",
"license": "229604",
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NH",
"license": "14493",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3084211",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.