Active NPI
Dmitry Vinnikov, RPA-C
- Medical Physician Assistant
- Brooklyn, NY
National Provider Identifier
1962738534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 013664
- Practice address
- 506 6TH St
Brooklyn, NY 11215-3609 - Phone
- (718) 780-3000
- NPI assigned
- Nov 2, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 013664 | NY | Primary |
Addresses
Primary practice location
506 6TH St
Brooklyn, NY 11215-3609
Mailing address
11701 Park LN S Apt D2G
Richmond Hill, NY 11418-1052
Phone (917) 885-5960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G400009079 | Other | NY | MEDICARE PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Current | Accepting new patients | |
| Montefiore Medical Center | Current | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
1250 Waters Pl
Ste 903
Bronx, NY 10461
Phone (718) 450-9955
1825 Eastchester Rd
Bronx, NY 10461
Phone (718) 904-2000
300 Community Dr
Plandome, NY 11030
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Bronx, NY
- NPI 1063525152
-
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380844800000",
"number": "1962738534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11701 PARK LN S APT D2G",
"city": "RICHMOND HILL",
"state": "NY",
"postal_code": "114181052",
"telephone_number": "917-885-5960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 6TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112153609",
"telephone_number": "718-780-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINNIKOV",
"first_name": "DMITRY",
"name_prefix": "Mr.",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-02",
"last_updated": "2013-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "013664",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER #",
"identifier": "G400009079",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.