Individual provider Active NPI

Yuriy Verpukhovskiy, M.D.

  • Neurology Physician
  • Panorama City, CA
National Provider Identifier
1053365270
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A76392 Issued in CA
Practice address
14860 Roscoe Blvd
Ste.306
Panorama City, CA 91402-4665
Phone
(818) 904-9200
Fax
(818) 904-9300
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X A76392 CA
Neurology Physician 2084N0400X A76392 CA Primary

Addresses

Primary practice location

14860 Roscoe Blvd
Ste.306
Panorama City, CA 91402-4665

Mailing address

14860 Roscoe Blvd
Ste.306
Panorama City, CA 91402-4665
Phone (818) 904-9200

Other identifiers 3

IdentifierTypeStateIssuer
00A763920MedicaidCA
A76392OtherARLICENSE
202824485OtherCATAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050620000082 CA Practitioner - Neurology 5698719714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

19231 Victory Blvd
Suite 204
Reseda, CA 91335-6331
Phone (818) 904-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A76392CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yuriy Verpukhovskiy MD Inc CurrentSince Jul 1, 2007 Accepting new patients
Tri Valley Neurology Medical Associates Inc. Neurology PastSince Jul 29, 2016 Accepting new patients

Locations

14901 Rinaldi St
Ste 325
Mission Hills, CA 91345
Phone (818) 898-9898

19231 Victory Blvd
Ste 204
Reseda, CA 91335
Phone (818) 342-6109

14860 Roscoe Blvd
Ste 306
Van Nuys, CA 91402
Phone (818) 616-2122

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395964800000",
    "number": "1053365270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD",
            "address_2": "STE.306",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024665",
            "telephone_number": "818-904-9200",
            "fax_number": "818-904-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD",
            "address_2": "STE.306",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024665",
            "telephone_number": "818-904-9200",
            "fax_number": "818-904-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERPUKHOVSKIY",
        "first_name": "YURIY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2014-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A76392",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A76392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A763920",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A76392",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "202824485",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panorama City, CA

Sources for this page

Verify at the official NPI Registry.