Individual provider Active NPI

Ilya Vishevsky, RDMS

  • Sonography Radiologic Technologist
  • Bellevue, WA
National Provider Identifier
1063407179
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sonography Radiologic TechnologistTaxonomy code 2471S1302X
Practice address
1611 116TH Ave NE Ste 207
Bellevue, WA 98004-3063
Phone
(425) 235-5984
Fax
(425) 226-6331
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sonography Radiologic Technologist 2471S1302X WA Primary

Addresses

Primary practice location

1611 116TH Ave NE Ste 207
Bellevue, WA 98004-3063

Mailing address

PO Box 33879
Seattle, WA 98133-0879
Phone (425) 235-5984

Other identifiers 1

IdentifierTypeStateIssuer
7072663MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
601470187WAMDSonography Radiologic Technologist

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Services, Inc. Past 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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1063407179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33879",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981330879",
            "telephone_number": "425-235-5984",
            "fax_number": "425-226-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 116TH AVE NE STE 207",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043063",
            "telephone_number": "425-235-5984",
            "fax_number": "425-226-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISHEVSKY",
        "first_name": "ILYA",
        "name_prefix": "Mr.",
        "credential": "RDMS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471S1302X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Sonography",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7072663",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.