Evgueni Roudachevski, D.O.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

A03199 Issued in AR

Legal business name

EVGUENI ROUDACHEVSKI, D.O.

Practice address

11912 Kanis Rd Ste F2
Little Rock, AR 72211-3771

Phone

(501) 227-8020

Fax

(501) 227-8826

NPI assigned

Sep 12, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Hapsy Glover, APN

Title

Apn

Phone

(501) 227-8020

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Evgueni Roudachevski DO2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Evgueni Roudachevski, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • Little Rock, AR
  • NPI 1023569852
  NPD tax ID

Locations

Practitioners 3

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

• Evgueni Roudachevski, DO

  • Geriatric Medicine (Internal Medicine) Physician
  • Little Rock, AR
  • NPI 1215993787
  NPD (past)
• Kimberly Sanders

  • Gerontology Nurse Practitioner
  • Little Rock, AR
  • NPI 1326346461
  NPD (past)
• Brittany Taylor, APRN

  • Primary Care Nurse Practitioner
  • Ward, AR
  • NPI 1609247998
  NPD (past)

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1073914719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11912 KANIS RD STE F2",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113771",
            "telephone_number": "501-227-8020",
            "fax_number": "501-227-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11912 KANIS RD STE F2",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113771",
            "telephone_number": "501-227-8020",
            "fax_number": "501-227-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVGUENI ROUDACHEVSKI, D.O.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-12",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "HAPSY",
        "authorized_official_title_or_position": "APN",
        "authorized_official_telephone_number": "501-227-8020",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "A03199",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "A03199",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1568763514",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186702758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Erica Ewings

• Assisted Living Facility in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.