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Physician Compare National (NPI:1841432937)

HEALTHCARE PROVIDER: THEODORE DAMIAN KORECKIJ M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information

NPI 1841432937
Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID 6800016296
Unique individual clinician ID assigned by PECOS
Professional Enrollment ID I20141120000987
Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name KORECKIJ
Individual professional last name
Provider First Name THEODORE
Individual professional first name
Provider Gender M
The provider's gender if the provider is a person.

Medical School Information

Medical School Name OTHER
Individual professional's medical school
Graduation Year 2006
Individual professional's medical school graduation year
Primary Specialty ORTHOPEDIC SURGERY
Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information

Organization Legal Name DICKSON DIVELEY MIDWEST ORTHOPAEDIC CLINIC LLC
Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID 1153225479
Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members 23
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address 4320 WORNALL RD
Group Practice or individual's line 1 address
Line 2 Street Address SUITE 610
Group Practice or individual's line 2 address
City KANSAS CITY
Group Practice or individual's city
State MO
Group Practice or individual's state
Zip Code 641113235
Group Practice or individual's zip code (9 digits when available)
Phone Number 9133197600
Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information

Hospital Affiliation CCN 1 170188
Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1 KANSAS CITY ORTHOPAEDIC INSTITUTE
Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2 260138
Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2 ST LUKES HOSPITAL OF KANSAS CITY
Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3 260009
Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3 BOTHWELL REGIONAL HEALTH CENTER
Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4 260216
Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4 SAINT LUKE'S EAST HOSPITAL
Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5 170104
Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5 SHAWNEE MISSION MEDICAL CENTER
Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment Y

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