Organization Active NPI

Yakov D Shaposhnikov MD, PC

  • Gastroenterology Physician
  • Las Vegas, NV
National Provider Identifier
1053655969
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
8002 Issued in NV
Legal business name
YAKOV D SHAPOSHNIKOV MD, PC
Practice address
2020 Wellness Way
Suite 406
Las Vegas, NV 89106-4000
Phone
(702) 737-3337
Fax
(702) 737-3965
NPI assigned
Nov 15, 2012
Organization subpart
Yes
Parent organization
YAKOV D SHAPOSHNIKOV MD, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. Yakov Shaposhnikov, MDNPI 1790710994
Title
Owner
Phone
(702) 737-3337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 8002 NV Primary

Addresses

Primary practice location

2020 Wellness Way
Suite 406
Las Vegas, NV 89106-4000

Mailing address

8617 Robinson Ridge Dr
Las Vegas, NV 89117-5807
Phone (702) 737-3337

Other identifiers 1

IdentifierTypeStateIssuer
002019051MedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121217000121 NV Part B Supplier - Clinic/Group Practice 5496907685 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory
Part of
Yakov D Shaposhnikov MD

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1053655969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8617 ROBINSON RIDGE DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891175807",
            "telephone_number": "702-737-3337",
            "fax_number": "702-737-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 WELLNESS WAY",
            "address_2": "SUITE 406",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064000",
            "telephone_number": "702-737-3337",
            "fax_number": "702-737-3965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAKOV D SHAPOSHNIKOV MD, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YAKOV D SHAPOSHNIKOV MD, PC",
        "enumeration_date": "2012-11-15",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SHAPOSHNIKOV",
        "authorized_official_first_name": "YAKOV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-737-3337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NV",
            "license": "8002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002019051",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.