Individual provider Active NPI

Robert Videyko, DC

  • Chiropractor
  • Newburyport, MA
National Provider Identifier
1043212814
Registry record updated Aug 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
647 Issued in MA
Practice address
128 State St
Newburyport, MA 01950-6629
Phone
(978) 465-1500
Fax
(978) 465-7501
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 647 MA Primary

Addresses

Primary practice location

128 State St
Newburyport, MA 01950-6629

Mailing address

128 State St
Newburyport, MA 01950-6629
Phone (978) 465-1500

Other identifiers 5

IdentifierTypeStateIssuer
67990OtherCIGNA
515906OtherAETNA
351205OtherMAHARVARD HEALTHCARE
711501OtherMATUFTS
Y35447OtherMABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040723000227 MA Practitioner - Chiropractic 6305826959 Practice locations: Newburyport, MA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

128 State St
Newburyport, MA 01950-6629
Phone (978) 465-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
647MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Videyko Chiropractic Chiropractor PastSince Jan 1, 1990 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346198400000",
    "number": "1043212814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 STATE ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019506629",
            "telephone_number": "978-465-1500",
            "fax_number": "978-465-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 STATE ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019506629",
            "telephone_number": "978-465-1500",
            "fax_number": "978-465-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDEYKO",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2012-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "67990",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "515906",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD HEALTHCARE",
            "identifier": "351205",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "711501",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y35447",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburyport, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.