NPIMap

Individual provider Active NPI

Paul Viktorovich Bobryshev, M.D.

  • Emergency Medicine Physician
  • Little Rock, AR
National Provider Identifier
1083980270
Registry record updated Dec 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
01075848A Issued in IN
Practice address
4301 W Markham St
Little Rock, AR 72205-7101
Phone
(870) 723-1595
NPI assigned
Apr 1, 2012
Last updated
Dec 23, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 01075848A IN Primary

Addresses

Primary practice location

4301 W Markham St
Little Rock, AR 72205-7101

Mailing address

317 N Spruce St
Little Rock, AR 72205-3838
Phone (870) 723-1595

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160630001374 NC Practitioner - Emergency Medicine 5597065359 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arkansas College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Emergency Physicians PAGroup PAC ID 9931002078, 269 clinicians

Practice addresses (Care Compare)

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Emergency Physicians PA Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Dec 1, 2017 Accepting new patients
Columbus Emergency Group LLC Emergency Medicine CurrentSince Oct 3, 2017 Accepting new patients
Wake Emergency Physicians PA Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Emergency Medicine Physicians of Mecklenburg County, PLLC Emergency Medicine CurrentSince Mar 1, 2025 Accepting new patients
Wake Emergency Physicians PA Emergency Medicine Current Accepting new patients

Locations

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

500 Jefferson St
Whiteville, NC 28472
Phone (910) 642-1776

Interoperability endpoints

  • Direct secure messaging: pbobryshev115530@directhisp.wakemed.org
  • Direct secure messaging: pbobryshev207411@direct.unc.nchie.net

Organizations & group practices 6

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1333238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450828800000",
    "number": "1083980270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 N SPRUCE ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053838",
            "telephone_number": "870-723-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "870-723-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBRYSHEV",
        "first_name": "PAUL",
        "middle_name": "VIKTOROVICH",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-01",
        "last_updated": "2015-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01075848A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.