Dmitriy Shchegolev

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

587208 Issued in MN

Practice address

14346 Wilson Dr
Eden Prairie, MN 55347-4179

Phone

(612) 250-1929

NPI assigned

Apr 14, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1053930578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14346 WILSON DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14346 WILSON DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553474179",
            "telephone_number": "612-250-1929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHCHEGOLEV",
        "first_name": "DMITRIY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "587208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmitriy.shchegolev@parknicollet.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6500 Excelsior Blvd",
            "city": "St Louis Park",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554264702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Diagnostic Radiology Physician in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.