ELIZABETH DIMITRIEVICH (MD) – Obstetrics & Gynecology Physician, NPI 1003834995
Obstetrics & Gynecology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,164 OBSTETRICS/GYNECOLOGY in TX
Provider Addresses for ELIZABETH DIMITRIEVICH (MD)
4801 Alberta Ave
El Paso, TX 799052707
Phone: (915) 215-5000
Type: Location
625, West 18th Street, Sioux Falls, Minnehaha County, South Dakota, 57105, United States
OBGYN SPECIALTY CLINIC
SIOUX FALLS, SD 57105
Phone: (605) 338-0836
Fax: (605) 338-7890
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-05-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20111128000321 | I | Obstetrics/Gynecology | SD | TBD |
| I20210715004224 | I | Obstetrics/Gynecology | MO | TBD |
| I20220519002480 | I | Obstetrics/Gynecology | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 79905)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| General Surgery | TN | |
| N E U R O L O G Y | TX | |
| Pediatric Medicine | TX | |
| - | TX | |
| O T O L A R Y N G O L O G Y | TX | |
| - | LA | |
| - | KS | |
| Emergency Medicine | IL | |
| - | MS | |
| Diagnostic Radiology, Interventional Radiology | ND |
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