DR. DMITRY FAMILTSEV (NPI# 1194161174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1194161174 |
Entity Type | Individual |
Full Name | DR. DMITRY FAMILTSEV |
Credential | M.D., PH.D. |
Practice Address |
1050 W 10th St Rolla MO 65401-2905 |
Practice Telephone | 5733081301 |
Practice Fax Number | 5732022480 |
Mailing Telephone | 5734262182 |
Mailing Fax Number | 5734265341 |
Enumeration Date | 2013-05-16 |
Last Update Date | 2019-08-21 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
2018013507 | MO | Allopathic & Osteopathic Physicians |
Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
2018013507 | MO | Allopathic & Osteopathic Physicians |
N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
Address | Telephone Number | Fax Number |
---|---|---|
1501 N Campbell Ave, Tucson, AZ 857240001 | 5206261416 | 5206264333 |
1050 W 10th St, Rolla, MO 654012905 | 5733081301 | 5732022480 |
Street Address |
1050 W 10TH ST |
City | ROLLA |
State | MO |
Zip Code | 65401-2905 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518962570 | Donald James Mcmullin | Internal Medicine | 1050 W 10th St, Rolla, MO 65401 | 2005-06-16 |
1366066037 | Pcrmc Medical Group, Inc | Clinic/Center | 1050 W 10th St, Rolla, MO 65401-2905 | 2020-05-29 |
1659857415 | Josie Leann Eoff | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2018-07-16 |
1659893758 | Joshua Thomas Turnbaugh | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2017-07-10 |
1700327897 | Emily Wiseman | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2017-03-09 |
1487046181 | Pamela N. Gray | Physician Assistant | 1050 W 10th St, Rolla, MO 65401-2905 | 2015-03-04 |
1174928857 | Arezo Hesaraki | Dentist | 1050 W 10th St, Ste 480, Rolla, MO 65401-2905 | 2014-10-23 |
1922416296 | Karen Ulrich | Advanced Practice Midwife | 1050 W 10th St, Rolla, MO 65401-2905 | 2014-07-30 |
1093142531 | Meredith Leigh Napierala | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-09-30 |
1528409638 | Curtis Morrison | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-07-17 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639645591 | Samantha Jo Mitchell | Pharmacist | 1375 E 10th St Suite B, Rolla, MO 65401 | 2018-10-18 |
1427567726 | Gerry Wade Funkhouser Jr. | Counselor | 103 W 10th St, Rolla, MO 65401 | 2017-09-29 |
1366967960 | Shana Hintz Wisniewski | Social Worker | 1000 W. 10th St., Rolla, MO 65401 | 2017-08-04 |
1174066559 | Tabitha Hundt | Counselor | 1011 Cypress Dr, Rolla, MO 65401 | 2016-12-02 |
1841742855 | Alpha Assisted Living LLC | Assisted Living Facility | 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 | 2016-10-26 |
1275916884 | Elizabeth Zersen | Occupational Therapist | 2053 Vienna Rd, Rolla, MO 65401 | 2015-06-30 |
1386047025 | Becky L Witham | Nurse Practitioner | 1060 W 10th Street, Rolla, MO 65401 | 2014-10-08 |
1114326121 | Summer Adey | Licensed Practical Nurse | 13750 State Route F, Rolla, MO 65401 | 2014-08-14 |
1518303296 | Leaetta Mildred Gardner | Nursing Facility/Intermediate Care Facility | 13450 County Road 7040, Rolla, MO 65401 | 2013-05-21 |
1316282064 | Susan Peitz Gruener | Occupational Therapy Assistant | 1800 White Column Road, Rolla, MO 65401 | 2012-12-06 |
Find all providers in zip 65401 |
Taxonomy Code | 207RI0011X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Interventional Cardiology |
An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114215134 | Arslan Shaukat | Internal Medicine | 1000 W 10th St, Rolla, MO 65401 | 2011-07-11 |
1063411999 | James J Spadaro Jr. | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2005-07-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275032286 | Cardiac Cin of Kansas City LLC | Internal Medicine | 111 W 10th St Ste 103, Kansas City, MO 64105-1700 | 2018-02-05 |
1437658440 | Cardiac Cin of St Louis LLC | Internal Medicine | 11628 Old Ballas Rd # 346, Saint Louis, MO 63141-7030 | 2018-02-05 |
1629366984 | Jorge Marcelo Ramirez Romero | Internal Medicine | 1402 S. Grand, Fdt 14th Floor, St. Louis, MO 63104 | 2011-07-20 |
1164737490 | Mohan Mallikarjuna Edupuganti | Internal Medicine | 901 Patients First Dr Ste 2500, Washington, MO 63090 | 2010-08-11 |
1285945295 | Byungsoo Ko | Internal Medicine | 100 Mercy Way Ste 320, Joplin, MO 64804-4524 | 2010-06-24 |
1033370358 | Shamail S. Tariq | Internal Medicine | 1071 Airport Rd, Festus, MO 63028-4103 | 2008-06-19 |
1104083351 | Cardiovascular Institute of Jacksonville P A | Internal Medicine | 1406 Ridgetree Trails Dr, Wildwood, MO 63021-5930 | 2008-05-16 |
1053401422 | Gus Theodos | Internal Medicine | 710 S Price Rd, Saint Louis, MO 63124-1867 | 2006-10-13 |
1225134117 | William R Reilly Inc | Internal Medicine | 450 N. New Ballas Rd, Ste 170w, St. Louis, MO 63141-6835 | 2006-09-16 |
1881799336 | Morton R. Rinder | Internal Medicine | 222 S Woods Mill Rd Ste 560, Chesterfield, MO 63017-3625 | 2006-09-13 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.